Healthcare Provider Details

I. General information

NPI: 1225534464
Provider Name (Legal Business Name): ABIDUR RAHMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3713 85TH ST
JACKSON HEIGHTS NY
11372-7352
US

IV. Provider business mailing address

3713 85TH ST
JACKSON HEIGHTS NY
11372-7352
US

V. Phone/Fax

Practice location:
  • Phone: 347-507-0280
  • Fax: 332-249-1489
Mailing address:
  • Phone: 347-507-0280
  • Fax: 332-249-1489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number007169-01
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: