Basic Information
Provider Information
NPI: 1144590498
EntityType: 2
ReplacementNPI:  
OrganizationName: PROFESSIONAL MEDICAL HEALTHCARE P.C.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5911 16 AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 11204
CountryCode: US
TelephoneNumber: 7186456434
FaxNumber:  
Practice Location
Address1: 5911 16TH AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112042114
CountryCode: US
TelephoneNumber: 7186456434
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/04/2012
LastUpdateDate: 01/04/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: AMOASHIY
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 7186456434
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
173000000X211960NYY193200000X MULTI-SPECIALTY GROUPOther Service ProvidersLegal Medicine 

ID Information
IDTypeStateIssuerDescription
0187763205NY MEDICAID


Home