# TRI-BOROUGH NY MEDICAL PRACTICE PC

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

## Provider details

- **NPI number:** 1720661044
- **Authorized official:** MISS NEESHA N MOHAMMED (PRACTICE MANAGER)
- **Authorized official phone:** (855) 699-7246

## Contact information

- **Practice address:** 9016 SUTPHIN BLVD, JAMAICA, NY 11435-3636
- **Practice address phone:** (719) 487-4016
- **Mailing address:** 185 KINGSLAND ST, NUTLEY, NJ 07110-1119
- **Mailing address phone:** (855) 699-7246
- **Mailing address fax:** (718) 766-9763

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | — | NULL | — |
| 174400000X | Specialist | — | — | — |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |
| 363AS0400X | Surgical Physician Assistant | — | NULL | — |
| 363AS0400X | Surgical Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 05/04/2021
- **Last updated:** 05/04/2021