Provider Demographics
NPI:1659898443
Name:BROADWAY MEDICAL CARE, P.C.
Entity Type:Organization
Organization Name:BROADWAY MEDICAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DILRUBA
Authorized Official - Middle Name:RASHIDUN
Authorized Official - Last Name:NABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-204-2067
Mailing Address - Street 1:4114 JUDGE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2344
Mailing Address - Country:US
Mailing Address - Phone:718-424-3131
Mailing Address - Fax:718-606-8783
Practice Address - Street 1:4117 JUDGE ST FL 1
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-2343
Practice Address - Country:US
Practice Address - Phone:717-424-3131
Practice Address - Fax:718-606-6783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNABI205570207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01843681Medicaid