Provider Demographics
NPI:1801223474
Name:RJM MEDICAL OF JACKSON HEIGHTS PC
Entity Type:Organization
Organization Name:RJM MEDICAL OF JACKSON HEIGHTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHHAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-481-1980
Mailing Address - Street 1:87-15 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-480-1980
Mailing Address - Fax:
Practice Address - Street 1:8715 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7701
Practice Address - Country:US
Practice Address - Phone:718-480-1980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty