Provider Demographics
NPI:1366657991
Name:COMMUNITY MEDICAL CARE PC
Entity Type:Organization
Organization Name:COMMUNITY MEDICAL CARE PC
Other - Org Name:COMMUNITY MEDICAL CARE .PC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NASREEN
Authorized Official - Middle Name:SIDDIQUI
Authorized Official - Last Name:SARFARAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-454-1732
Mailing Address - Street 1:62 DALEY ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3604
Mailing Address - Country:US
Mailing Address - Phone:718-454-1732
Mailing Address - Fax:718-454-1564
Practice Address - Street 1:19909 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2130
Practice Address - Country:US
Practice Address - Phone:718-454-1732
Practice Address - Fax:718-454-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02129179Medicaid
NY02129179Medicaid
NY07001Medicare PIN