Provider Demographics
NPI:1972937126
Name:BMI CLINIC CORP
Entity Type:Organization
Organization Name:BMI CLINIC CORP
Other - Org Name:INTRIMMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:JAZAYERI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-528-1092
Mailing Address - Street 1:25325 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1458
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25325 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1458
Practice Address - Country:US
Practice Address - Phone:917-528-1092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053328132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Single Specialty