Provider Demographics
NPI:1043563554
Name:OPTIMUM PRIMARY CARE MEDICAL PC
Entity Type:Organization
Organization Name:OPTIMUM PRIMARY CARE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M,D,
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-361-4600
Mailing Address - Street 1:52 WOODHOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2217
Mailing Address - Country:US
Mailing Address - Phone:516-361-4600
Mailing Address - Fax:
Practice Address - Street 1:311 ST. NICHOLAS AVENUE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-766-5150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty