Healthcare Provider Details

I. General information

NPI: 1306925201
Provider Name (Legal Business Name): MARIAM R HUDA MD FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N PORTLAND AVE CUMBERLAND DIAG & TREAT CENTER
BROOKLYN NY
11205
US

IV. Provider business mailing address

6380 WETHEROLE ST APT 25
REGO PARK NY
11374
US

V. Phone/Fax

Practice location:
  • Phone: 718-260-7760
  • Fax:
Mailing address:
  • Phone: 718-897-5274
  • Fax: 718-897-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number146709
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: