Provider Demographics
NPI:1124781398
Name:MEDICAL PROFESSIONAL HEALTHCARE WOODSIDE P.C.
Entity type:Organization
Organization Name:MEDICAL PROFESSIONAL HEALTHCARE WOODSIDE P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAHIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-550-2273
Mailing Address - Street 1:6527 ROOSEVELT AVE # 1A
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2927
Mailing Address - Country:US
Mailing Address - Phone:718-550-2273
Mailing Address - Fax:718-550-2274
Practice Address - Street 1:6527 ROOSEVELT AVE # 1A
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2927
Practice Address - Country:US
Practice Address - Phone:718-550-2273
Practice Address - Fax:718-550-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No291U00000XLaboratoriesClinical Medical Laboratory