Provider Demographics
NPI:1942922471
Name:PROFESSIONAL PRIMARY CARE PHYSICIAN PLLC
Entity Type:Organization
Organization Name:PROFESSIONAL PRIMARY CARE PHYSICIAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FOZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JANGDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-749-2468
Mailing Address - Street 1:83 MCINTOSH CT
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1039
Mailing Address - Country:US
Mailing Address - Phone:718-749-2468
Mailing Address - Fax:
Practice Address - Street 1:388 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2524
Practice Address - Country:US
Practice Address - Phone:516-519-8831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty