Provider Demographics
NPI:1811367329
Name:124-15 MEDICAL PC
Entity Type:Organization
Organization Name:124-15 MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MUZAFFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-807-2477
Mailing Address - Street 1:88 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4131
Mailing Address - Country:US
Mailing Address - Phone:631-807-2477
Mailing Address - Fax:
Practice Address - Street 1:12415 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2649
Practice Address - Country:US
Practice Address - Phone:718-480-6626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty