Provider Demographics
NPI:1780896506
Name:ABDUL G.MUNDIA PHYSICIAN PC
Entity type:Organization
Organization Name:ABDUL G.MUNDIA PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:G
Authorized Official - Last Name:MUNDIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-763-1962
Mailing Address - Street 1:2000 N VILLAGE AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-1078
Mailing Address - Country:US
Mailing Address - Phone:516-763-1962
Mailing Address - Fax:516-764-0060
Practice Address - Street 1:2000 N VILLAGE AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-1078
Practice Address - Country:US
Practice Address - Phone:516-763-1962
Practice Address - Fax:516-764-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119258207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00398614Medicaid
NYB12597Medicare UPIN
NY00398614Medicaid