Healthcare Provider Details

I. General information

NPI: 1427312446
Provider Name (Legal Business Name): DEWAN S RAHMAN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL RD
EAST PATCHOGUE NY
11772-8809
US

IV. Provider business mailing address

100 HOSPITAL RD 203
EAST PATCHOGUE NY
11772-8814
US

V. Phone/Fax

Practice location:
  • Phone: 631-447-3010
  • Fax:
Mailing address:
  • Phone: 631-475-6900
  • Fax: 631-447-5954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number276123
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: