Basic Information
| Provider Information | |||||||||
| NPI: | 1295990737 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KNICKERBOCKER MEDICAL CARE P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 739 KNICKERBOCKER AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112215336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184561900 | ||||||||
| FaxNumber: | 7184568709 | ||||||||
| Practice Location | |||||||||
| Address1: | 8820 169TH ST | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114324431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187391199 | ||||||||
| FaxNumber: | 7187391579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2008 | ||||||||
| LastUpdateDate: | 07/31/2008 | ||||||||
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| AuthorizedOfficialLastName: | HASSAN | ||||||||
| AuthorizedOfficialFirstName: | SYED | ||||||||
| AuthorizedOfficialMiddleName: | SHAHID | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D. | ||||||||
| AuthorizedOfficialTelephone: | 7184561900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 209514 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 196128 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.