Healthcare Provider Details

I. General information

NPI: 1699664680
Provider Name (Legal Business Name): SAAD HABIB-E-RASUL MULLAH MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ELM ST
NEW MILFORD CT
06776-2993
US

IV. Provider business mailing address

210 BARBARA JEAN DR
ENFIELD CT
06082-2182
US

V. Phone/Fax

Practice location:
  • Phone: 860-210-5044
  • Fax: 203-749-9167
Mailing address:
  • Phone: 301-263-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1.085012-RES
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: