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NPI Code Detail

MEDICARE: CRESCENT INTEGRATIVE MEDICAL PLLC

MEDICARE: CRESCENT INTEGRATIVE MEDICAL PLLC
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1881424885
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESCENT INTEGRATIVE MEDICAL PLLC
Provider Business Mailing Address
First Line : 235 FOREST AVE
Second Line :
City : GLEN COVE
State : NY
Zip : 11542-2034
Country : US
Telephone Number : 516-671-7770
Fax Number :
Provider Business Practice Location Address
First Line : 235 FOREST AVE
Second Line :
City : GLEN COVE
State : NY
Zip : 11542-2034
Country : US
Telephone Number : 516-671-7770
Fax Number :
Authorized Official
Title or Position : MD
Name : KHAWAJA SIDDIQUE
Credential :
Telephone Number : 516-671-7770
Provider Enumeration Date : 08/05/2024
Last Update Date : 08/05/2024

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Directions to “CRESCENT INTEGRATIVE MEDICAL PLLC ” Practice Location

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