Provider Demographics
NPI: | 1558761387 |
---|---|
Name: | AFROZE OB/GYN MEDICAL P C |
Entity Type: | Organization |
Organization Name: | AFROZE OB/GYN MEDICAL P C |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SALMA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | AFROZE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PRESIDENT |
Authorized Official - Phone: | 516-841-7793 |
Mailing Address - Street 1: | 15 FIELDING AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | DIX HILLS |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11746-7139 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 516-841-7793 |
Mailing Address - Fax: | 516-706-6026 |
Practice Address - Street 1: | 17012 HILLSIDE AVE |
Practice Address - Street 2: | |
Practice Address - City: | JAMAICA |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11432-4547 |
Practice Address - Country: | US |
Practice Address - Phone: | 516-841-7793 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-08-29 |
Last Update Date: | 2014-08-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 243749 | 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Single Specialty |