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NPI Code Detail

MEDICARE: CLERISY MEDICAL, PC

MEDICARE: CLERISY MEDICAL, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist228737NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700047289
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLERISY MEDICAL, PC
Provider Business Mailing Address
First Line : 114 TALLEY RD S
Second Line :
City : ROSLYN
State : NY
Zip : 11576-2598
Country : US
Telephone Number : 718-421-2131
Fax Number : 718-421-2130
Provider Business Practice Location Address
First Line : 446 MCDONALD AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11218-2212
Country : US
Telephone Number : 718-972-4200
Fax Number : 718-972-6861
Authorized Official
Title or Position : OWNER
Name : DR. GULAM M KHAN
Credential : M.D.
Telephone Number : 718-840-7142
Provider Enumeration Date : 06/18/2008
Last Update Date : 07/20/2012

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