Provider Demographics
NPI:1568504306
Name:JAMIL, SYED A (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:A
Last Name:JAMIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7941
Mailing Address - Country:US
Mailing Address - Phone:800-846-5946
Mailing Address - Fax:
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:800-846-5946
Practice Address - Fax:718-963-6570
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01257809Medicaid
NY113056337OtherEIN
NY113056337OtherEIN
NY01257809Medicaid