Provider Demographics
NPI:1578014197
Name:IMTIAZ MEDICAL CARE PLLC
Entity type:Organization
Organization Name:IMTIAZ MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-676-0085
Mailing Address - Street 1:346 CONEY ISLAND AVE STE 50
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1804
Mailing Address - Country:US
Mailing Address - Phone:917-676-0085
Mailing Address - Fax:
Practice Address - Street 1:346 CONEY ISLAND AVE STE 50
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1804
Practice Address - Country:US
Practice Address - Phone:917-676-0085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty