Healthcare Provider Details

I. General information

NPI: 1285517656
Provider Name (Legal Business Name): MD SANJIDUL ALAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MERRICK AVE
EAST MEADOW NY
11554-1578
US

IV. Provider business mailing address

131 N RICHMOND AVE
ATLANTIC CITY NJ
08401-3425
US

V. Phone/Fax

Practice location:
  • Phone: 516-587-9960
  • Fax:
Mailing address:
  • Phone: 404-448-9306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP136122
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: