Provider Demographics
NPI:1689646424
Name:FELIX I OVIASU MD PC AND MOHAMMED MUNEERUDDIN PHYSICIAN PC LLP
Entity Type:Organization
Organization Name:FELIX I OVIASU MD PC AND MOHAMMED MUNEERUDDIN PHYSICIAN PC LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:I
Authorized Official - Last Name:OVIASU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-742-5700
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-0253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 GARDEN CITY PLZ
Practice Address - Street 2:SUITE 303
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3322
Practice Address - Country:US
Practice Address - Phone:516-742-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167440174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CG0531Medicare PIN
NYW85752Medicare ID - Type Unspecified