1902461270 NPI number — M L NAHAR MEDICAL OFFICE PLLC

Table of content: (NPI 1902461270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902461270 NPI number — M L NAHAR MEDICAL OFFICE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M L NAHAR MEDICAL OFFICE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902461270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
92 FAIRVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBERTSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11507-1008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-360-0907
Provider Business Mailing Address Fax Number:
718-395-1737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8712 175TH ST UNIT 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-5776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-360-0907
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2019

Additional Information

Authorized Official

Authorized Official Last Name:
NAHAR
Authorized Official First Name:
MOST
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
917-284-5361

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03343102 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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