Provider Demographics
NPI:1790845584
Name:VXL MEDICAL CARE P.C.
Entity Type:Organization
Organization Name:VXL MEDICAL CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ASLAM
Authorized Official - Middle Name:AZIZ
Authorized Official - Last Name:JIVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-280-9680
Mailing Address - Street 1:34 PATTON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1731
Mailing Address - Country:US
Mailing Address - Phone:917-826-0886
Mailing Address - Fax:718-899-3300
Practice Address - Street 1:8812 QUEENS BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4489
Practice Address - Country:US
Practice Address - Phone:718-280-9680
Practice Address - Fax:718-899-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216241207R00000X, 207RP1001X
NY242038207RG0300X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02053029Medicaid
NYH10650Medicare UPIN
NY05821Medicare ID - Type Unspecified