Provider Demographics
NPI:1447528864
Name:OPTIMAL HEALTH MEDICAL PC
Entity type:Organization
Organization Name:OPTIMAL HEALTH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:NARENDRA
Authorized Official - Last Name:KIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-421-6101
Mailing Address - Street 1:101 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2518
Mailing Address - Country:US
Mailing Address - Phone:516-755-5855
Mailing Address - Fax:516-755-0330
Practice Address - Street 1:101 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2518
Practice Address - Country:US
Practice Address - Phone:516-755-5855
Practice Address - Fax:516-755-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259884261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty