| Advanced Internal Medicine, P.c. | |
|
935 Northern Blvd Ste 105 Great Neck NY 11021-5309 | |
| (516) 487-0070 | |
| (516) 487-0072 |
| Full Name | Advanced Internal Medicine, P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 935 Northern Blvd Ste 105, Great Neck, New York |
| Authorized Official Name and Position | Shahram Daniel Shamekh (PRESIDENT/CEO) |
| Authorized Official Contact | 5164557017 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Internal Medicine, P.c. 130 Gristmill Ln Great Neck NY 11023-1839 Ph: (516) 455-7017 | Advanced Internal Medicine, P.c. 935 Northern Blvd Ste 105 Great Neck NY 11021-5309 Ph: (516) 487-0070 |
| NPI Number | 1467709451 |
|---|---|
| Provider Enumeration Date | 08/08/2012 |
| Last Update Date | 11/28/2018 |
| Medicare PECOS PAC ID | 5294971230 |
|---|---|
| Medicare Enrollment ID | O20130418000341 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467709451 | NPI | - | NPPES |
| 02708294 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 236142 (New York) | Primary |
| Provider Name | Shahram Hormozi |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1215916721 PECOS PAC ID: 0143210724 Enrollment ID: I20040515000015 |
| Provider Name | Shahram Daniel Shamekh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063468627 PECOS PAC ID: 6406872696 Enrollment ID: I20051017001160 |
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