Provider Demographics
NPI:1164149001
Name:HAMZA JALAL DO PLLC
Entity Type:Organization
Organization Name:HAMZA JALAL DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMZA
Authorized Official - Middle Name:
Authorized Official - Last Name:JALAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-572-9139
Mailing Address - Street 1:16055 CROSS BAY BLVD
Mailing Address - Street 2:UNIT A
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3450
Mailing Address - Country:US
Mailing Address - Phone:718-210-4738
Mailing Address - Fax:888-498-4123
Practice Address - Street 1:16055 CROSS BAY BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3450
Practice Address - Country:US
Practice Address - Phone:718-210-4738
Practice Address - Fax:888-498-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty