Healthcare Provider Details

I. General information

NPI: 1396612289
Provider Name (Legal Business Name): MAHFUZUL HAQUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14841A HILLSIDE AVE
JAMAICA NY
11435-3330
US

IV. Provider business mailing address

14841A HILLSIDE AVE
JAMAICA NY
11435-3330
US

V. Phone/Fax

Practice location:
  • Phone: 718-647-4444
  • Fax: 917-810-7600
Mailing address:
  • Phone: 718-647-4444
  • Fax: 917-810-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: