Basic Information
| Provider Information | |||||||||
| NPI: | 1114960986 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NY MEDICAL HEALTH CARE PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NY MEDICAL HEALTHCARE PC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6902 AUSTIN ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187936800 | ||||||||
| FaxNumber: | 3473924179 | ||||||||
| Practice Location | |||||||||
| Address1: | 6902 AUSTIN ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113754250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187936800 | ||||||||
| FaxNumber: | 3473924179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 12/07/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GOLYAN | ||||||||
| AuthorizedOfficialFirstName: | BIJAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7187936800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.