Provider Demographics
NPI:1699834036
Name:MOHAMMAD M KAMAL PHYSICIAN PC
Entity Type:Organization
Organization Name:MOHAMMAD M KAMAL PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:MOSTAFA
Authorized Official - Last Name:KAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-431-0009
Mailing Address - Street 1:79 CHURCH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218
Mailing Address - Country:US
Mailing Address - Phone:718-431-0009
Mailing Address - Fax:718-431-0451
Practice Address - Street 1:79 CHURCH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218
Practice Address - Country:US
Practice Address - Phone:718-431-0009
Practice Address - Fax:718-431-0451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02008648Medicaid
NY5068A1Medicare ID - Type Unspecified
H99982Medicare UPIN