Provider Demographics
NPI:1871230813
Name:COLUMBIA MEDICAL OF NY, P.C.
Entity Type:Organization
Organization Name:COLUMBIA MEDICAL OF NY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOIN
Authorized Official - Middle Name:U
Authorized Official - Last Name:MALLHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-338-5382
Mailing Address - Street 1:3857 KINGS HWY APT 1L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2949
Mailing Address - Country:US
Mailing Address - Phone:718-338-5382
Mailing Address - Fax:718-338-2032
Practice Address - Street 1:3857 KINGS HWY APT 1L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2949
Practice Address - Country:US
Practice Address - Phone:718-338-5382
Practice Address - Fax:718-338-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty