1871038315 NPI number — WESTERN CARE MEDICAL PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871038315 NPI number — WESTERN CARE MEDICAL PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN CARE MEDICAL PC
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:
1871038315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7017 37TH AVE
Provider Second Line Business Mailing Address:
1ST FLR
Provider Business Mailing Address City Name:
JACKSON HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11372-3922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-565-5600
Provider Business Mailing Address Fax Number:
718-565-5600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7017 37TH AVE
Provider Second Line Business Practice Location Address:
1ST FLR
Provider Business Practice Location Address City Name:
JACKSON HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11372-3922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-565-5600
Provider Business Practice Location Address Fax Number:
718-565-5600
Provider Enumeration Date:
12/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KHANDKER
Authorized Official First Name:
FERDOUS
Authorized Official Middle Name:
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
718-565-5600

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  22523 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02300407 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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