Provider Demographics
NPI:1225559990
Name:PS MEDICAL CARE OF ELMONT PLLC
Entity type:Organization
Organization Name:PS MEDICAL CARE OF ELMONT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-766-4777
Mailing Address - Street 1:20B MEACHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2654
Mailing Address - Country:US
Mailing Address - Phone:516-502-9355
Mailing Address - Fax:888-858-2068
Practice Address - Street 1:20B MEACHAM AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2654
Practice Address - Country:US
Practice Address - Phone:516-502-9355
Practice Address - Fax:888-858-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-03
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY268169OtherLICENSE