Healthcare Provider Details

I. General information

NPI: 1649878604
Provider Name (Legal Business Name): TABRAIZ RASUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD
BRENTWOOD NY
11717-1019
US

IV. Provider business mailing address

43 BUTTONWOOD DR
DIX HILLS NY
11746-4802
US

V. Phone/Fax

Practice location:
  • Phone: 631-761-3500
  • Fax:
Mailing address:
  • Phone: 516-855-5255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number79426
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number338769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: