Healthcare Provider Details

I. General information

NPI: 1790617272
Provider Name (Legal Business Name): ABDUL HAMID PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 21ST ST APT 3E
LONG ISLAND CITY NY
11101-5225
US

IV. Provider business mailing address

4505 21ST ST APT 3E
LONG ISLAND CITY NY
11101-5225
US

V. Phone/Fax

Practice location:
  • Phone: 718-869-0330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: