Healthcare Provider Details

I. General information

NPI: 1982990495
Provider Name (Legal Business Name): MD ASHFIQUR RAHMAN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210-08 NORTHERN BOULEVARD SUITE 1A
BAYSIDE NY
11361-3211
US

IV. Provider business mailing address

65-11 BOOTH STREET SUITE 1C
REGO PARK NY
11374-4184
US

V. Phone/Fax

Practice location:
  • Phone: 718-806-1434
  • Fax: 718-806-1435
Mailing address:
  • Phone: 718-806-1434
  • Fax: 718-806-1435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number277662
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: