Healthcare Provider Details

I. General information

NPI: 1548192552
Provider Name (Legal Business Name): MD SHAFWANUR RAHMAN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 S ALBANY ST
ITHACA NY
14850-5406
US

IV. Provider business mailing address

1583 E 66TH ST FL 1
BROOKLYN NY
11234-6005
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-4166
  • Fax: 607-277-7004
Mailing address:
  • Phone: 516-862-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP142296
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: