Provider Demographics
NPI:1962758557
Name:JAHAN MEDICAL SERVICE PC
Entity type:Organization
Organization Name:JAHAN MEDICAL SERVICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MUMTAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-576-6667
Mailing Address - Street 1:27 48 BUTLER STREET
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1928
Mailing Address - Country:US
Mailing Address - Phone:646-942-4308
Mailing Address - Fax:718-853-3968
Practice Address - Street 1:509 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3885
Practice Address - Country:US
Practice Address - Phone:718-576-6667
Practice Address - Fax:718-853-3968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216654207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty