Healthcare Provider Details

I. General information

NPI: 1962812248
Provider Name (Legal Business Name): MARUFA KHATUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14015 SANFORD AVE
FLUSHING NY
11355-2686
US

IV. Provider business mailing address

441 9TH AVE
NEW YORK NY
10001-1623
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number285757
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: