Healthcare Provider Details

I. General information

NPI: 1609644681
Provider Name (Legal Business Name): MD MASUD BILLAH MEDICAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BAYVIEW AVE
MASSAPEQUA NY
11758-8012
US

IV. Provider business mailing address

275 BAYVIEW AVE
MASSAPEQUA NY
11758-8012
US

V. Phone/Fax

Practice location:
  • Phone: 646-642-7029
  • Fax:
Mailing address:
  • Phone: 646-642-7029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MASUD BILLAH
Title or Position: OWNER
Credential: MD
Phone: 646-642-7029