Provider Demographics
NPI:1245526987
Name:NEW LIFE MEDICAL SERVICES PC
Entity type:Organization
Organization Name:NEW LIFE MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RABEYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-294-9808
Mailing Address - Street 1:91-12 175 STREET
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5561
Mailing Address - Country:US
Mailing Address - Phone:718-206-2688
Mailing Address - Fax:718-206-2687
Practice Address - Street 1:91-12 175 STREET
Practice Address - Street 2:SUITE 1B
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5561
Practice Address - Country:US
Practice Address - Phone:718-206-2688
Practice Address - Fax:718-206-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242785207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02924069Medicaid
NY0105YWMedicare UPIN