Provider Demographics
NPI:1063424505
Name:NOSTRAND COMMUNITY MEDICAL P.C.
Entity type:Organization
Organization Name:NOSTRAND COMMUNITY MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-769-4988
Mailing Address - Street 1:2968 AVENUE X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1808
Mailing Address - Country:US
Mailing Address - Phone:718-769-4988
Mailing Address - Fax:718-769-4415
Practice Address - Street 1:2968 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1808
Practice Address - Country:US
Practice Address - Phone:718-769-7988
Practice Address - Fax:718-769-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226710305R00000X, 302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered305R00000XManaged Care OrganizationsPreferred Provider Organization
Not Answered302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133AG1Medicare ID - Type Unspecified
NYH85948Medicare UPIN