Provider Demographics
NPI:1023063484
Name:TOTAL HEALTH MEDICAL SERVICES, P.C.
Entity type:Organization
Organization Name:TOTAL HEALTH MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHOLOMHASSANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-634-7000
Mailing Address - Street 1:3778 ILLONA LN
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5973
Mailing Address - Country:US
Mailing Address - Phone:718-634-7000
Mailing Address - Fax:718-634-7000
Practice Address - Street 1:9511 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2224
Practice Address - Country:US
Practice Address - Phone:718-846-7500
Practice Address - Fax:718-846-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02045687Medicaid
NY02045687Medicaid
NY060809GMedicare PIN
NYG99970Medicare UPIN