Provider Demographics
NPI:1023147378
Name:FLORAL PARK MEDICAL PC
Entity type:Organization
Organization Name:FLORAL PARK MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HIMANSHU
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-903-3885
Mailing Address - Street 1:34 TOTTENHAM PL
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3517
Mailing Address - Country:US
Mailing Address - Phone:516-873-0304
Mailing Address - Fax:
Practice Address - Street 1:25720 HILLSIDE AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1653
Practice Address - Country:US
Practice Address - Phone:917-903-3885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
08027Medicare PIN
NYW12521Medicare PIN