Healthcare Provider Details

I. General information

NPI: 1700710407
Provider Name (Legal Business Name): PROMIE UDDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8403 57TH AVE
ELMHURST NY
11373-4833
US

IV. Provider business mailing address

10435 110TH ST
SOUTH RICHMOND HILL NY
11419-2411
US

V. Phone/Fax

Practice location:
  • Phone: 718-899-9060
  • Fax:
Mailing address:
  • Phone: 929-431-4627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131125-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: