Healthcare Provider Details

I. General information

NPI: 1154497865
Provider Name (Legal Business Name): MOHAMMAD QUAMRUZZAMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87-25, HOMELAWN STREET 1ST FLOOR
JAMAICA NY
11432
US

IV. Provider business mailing address

15018 75TH AVE 3G
FLUSHING NY
11367-2925
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-1117
  • Fax: 718-383-8047
Mailing address:
  • Phone: 718-268-7586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number228779-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: