Basic Information
| Provider Information | |||||||||
| NPI: | 1932712049 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEFFERTS MEDICAL ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 808A HICKSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117581262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165974242 | ||||||||
| FaxNumber: | 5165974243 | ||||||||
| Practice Location | |||||||||
| Address1: | 808A HICKSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117581262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165974242 | ||||||||
| FaxNumber: | 5165974243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2020 | ||||||||
| LastUpdateDate: | 08/28/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHHABRA | ||||||||
| AuthorizedOfficialFirstName: | INDERPAL | ||||||||
| AuthorizedOfficialMiddleName: | SINGH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7183470434 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | LEFFERTS MEDICAL ASSOCIATES PC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | 207R00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.