Provider Demographics
NPI:1871038315
Name:WESTERN CARE MEDICAL PC
Entity Type:Organization
Organization Name:WESTERN CARE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:FERDOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANDKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-565-5600
Mailing Address - Street 1:7017 37TH AVE
Mailing Address - Street 2:1ST FLR
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-3922
Mailing Address - Country:US
Mailing Address - Phone:718-565-5600
Mailing Address - Fax:718-565-5600
Practice Address - Street 1:7017 37TH AVE
Practice Address - Street 2:1ST FLR
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3922
Practice Address - Country:US
Practice Address - Phone:718-565-5600
Practice Address - Fax:718-565-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02300407Medicaid