Provider Demographics
NPI:1205336591
Name:OZONE PARK QUALITY CARE MEDICINE PLLC
Entity type:Organization
Organization Name:OZONE PARK QUALITY CARE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUSAMMAT
Authorized Official - Middle Name:ROUNAK
Authorized Official - Last Name:JAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-322-4014
Mailing Address - Street 1:1 JARA CT
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3117
Mailing Address - Country:US
Mailing Address - Phone:718-322-4014
Mailing Address - Fax:718-322-4015
Practice Address - Street 1:7721 101ST AVE FL 1
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416
Practice Address - Country:US
Practice Address - Phone:718-322-4014
Practice Address - Fax:718-322-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
NY285335261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1699188680Medicaid