| Optimum Primary Care Medical Pc | |
|
311 St. Nicholas Avenue Ridgewood NY 11385 | |
| (718) 766-5150 | |
| Not Available |
| Full Name | Optimum Primary Care Medical Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 311 St. Nicholas Avenue, Ridgewood, New York |
| Authorized Official Name and Position | Mohammad Aslam (M,D,) |
| Authorized Official Contact | 5163614600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimum Primary Care Medical Pc 52 Woodhollow Rd Roslyn Heights NY 11577-2217 Ph: (516) 361-4600 | Optimum Primary Care Medical Pc 311 St. Nicholas Avenue Ridgewood NY 11385 Ph: (718) 766-5150 |
| NPI Number | 1043563554 |
|---|---|
| Provider Enumeration Date | 10/22/2012 |
| Last Update Date | 10/22/2012 |
| Medicare PECOS PAC ID | 4880847243 |
|---|---|
| Medicare Enrollment ID | O20130115000106 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043563554 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Mohammad Aslam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821197708 PECOS PAC ID: 7214031632 Enrollment ID: I20070324000047 |
| Provider Name | Jean Wany |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376938803 PECOS PAC ID: 8022338599 Enrollment ID: I20150522002086 |
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