Provider Demographics
NPI:1487655031
Name:GEO MEDICAL CARE PC
Entity Type:Organization
Organization Name:GEO MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NASRULLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-434-7545
Mailing Address - Street 1:26 NEWKIRK PLZ
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6525
Mailing Address - Country:US
Mailing Address - Phone:718-434-7545
Mailing Address - Fax:718-434-7564
Practice Address - Street 1:26 NEWKIRK PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6525
Practice Address - Country:US
Practice Address - Phone:718-434-7545
Practice Address - Fax:718-434-7564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-04
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195819207R00000X
NY227066207R00000X
NY204511208000000X
NY210632208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01689409Medicaid
NY539423Medicare PIN
NY01689409Medicaid
NYWNW961Medicare Oscar/Certification
NY539421Medicare PIN