| Medical Office Pc | |
|
120 Old Farmers Ln Staten Island NY 10304-1404 | |
| (718) 306-5025 | |
| (718) 462-8000 |
| Full Name | Medical Office Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 120 Old Farmers Ln, Staten Island, New York |
| Authorized Official Name and Position | Imaduddin Hashmi (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7183065025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Office Pc 62 New St Lynbrook NY 11563-3309 Ph: (718) 306-5025 | Medical Office Pc 120 Old Farmers Ln Staten Island NY 10304-1404 Ph: (718) 306-5025 |
| NPI Number | 1225002785 |
|---|---|
| Provider Enumeration Date | 02/13/2006 |
| Last Update Date | 02/14/2022 |
| Medicare PECOS PAC ID | 9830080589 |
|---|---|
| Medicare Enrollment ID | O20110804000636 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225002785 | NPI | - | NPPES |
| 01359457 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 184579 (New York) | Primary |
| Provider Name | Imaduddin Syed Hashmi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013198886 PECOS PAC ID: 3779475652 Enrollment ID: I20040325001687 |
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