Provider Demographics
NPI:1073648705
Name:HEMPSTEAD MAIN MEDICAL, PC
Entity Type:Organization
Organization Name:HEMPSTEAD MAIN MEDICAL, PC
Other - Org Name:HEMPSTEAD MAIN MEDICAL PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:877-276-9006
Mailing Address - Street 1:2 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4020
Mailing Address - Country:US
Mailing Address - Phone:516-489-6600
Mailing Address - Fax:516-489-6640
Practice Address - Street 1:2 MAIN ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4020
Practice Address - Country:US
Practice Address - Phone:516-489-6600
Practice Address - Fax:516-489-6640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02645169Medicaid
NY263381-2OtherLICENSE