Healthcare Provider Details

I. General information

NPI: 1245621069
Provider Name (Legal Business Name): MOHAMMAD RAHMAN MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170-12 HIGHLAND AVE, UNIT 101
JAMAICA ESTATES NY
11432
US

IV. Provider business mailing address

183-10 DANLY ROAD
JAMAICA ESTATES NY
11432
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-0700
  • Fax: 718-526-0800
Mailing address:
  • Phone: 718-526-0700
  • Fax: 718-526-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED MAHMUDUR RAHMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-864-8882