MEDICARE: MD MAHBUBUL ISLAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	243430	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285758276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MD MAHBUBUL ISLAM M.D.

Provider Business Mailing Address
First Line	:	18444 HENLEY RD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-2422
Country	:	US
Telephone Number	:	718-297-4110
Fax Number	:

Provider Business Practice Location Address
First Line	:	8786 188TH ST
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-1131
Country	:	US
Telephone Number	:	718-480-6882
Fax Number	:	718-454-5353

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	10/29/2016

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