Provider Demographics
NPI:1104199405
Name:JMSK MEDICAL
Entity Type:Organization
Organization Name:JMSK MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PANHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-464-6322
Mailing Address - Street 1:22648 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3129
Mailing Address - Country:US
Mailing Address - Phone:718-464-6322
Mailing Address - Fax:
Practice Address - Street 1:22648 76TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-3129
Practice Address - Country:US
Practice Address - Phone:718-464-6322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01583586Medicaid
NY01583586Medicaid