# JUMPSTART MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699430116
- **Authorized official:** DR. SHALENA ISLAM MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (917) 496-9000

## Contact information

- **Practice address:** 14242 BOOTH MEMORIAL AVE, FLUSHING, NY 11355-5387
- **Practice address phone:** (917) 496-9000
- **Mailing address:** 14242 BOOTH MEMORIAL AVE, FLUSHING, NY 11355-5387
- **Mailing address phone:** (917) 496-9000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/01/2021
- **Last updated:** 11/01/2021