Healthcare Provider Details

I. General information

NPI: 1780388561
Provider Name (Legal Business Name): HABIB RASOULLY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT OF PSYCHIATRY, MAIL CODE:164 2 CLARA BARTON DR
ALBANY NY
12208
US

IV. Provider business mailing address

DEPT OF PSYCHIATRY, MAIL CODE:164 2 CLARA BARTON DR
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5511
  • Fax:
Mailing address:
  • Phone: 518-262-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number335457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: