Provider Demographics
NPI:1639443179
Name:ISSA NAMAN MD PC
Entity Type:Organization
Organization Name:ISSA NAMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-651-5222
Mailing Address - Street 1:3201 75TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1807
Mailing Address - Country:US
Mailing Address - Phone:718-651-5222
Mailing Address - Fax:
Practice Address - Street 1:3201 75TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1807
Practice Address - Country:US
Practice Address - Phone:718-651-5222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133425207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY09864BMedicare UPIN