Healthcare Provider Details

I. General information

NPI: 1811401813
Provider Name (Legal Business Name): HASHIM H OTHMAN PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 MINEOLA BLVD
MINEOLA NY
11501-2513
US

IV. Provider business mailing address

481 EDWARD H ROSS DR
ELMWOOD PARK NJ
07407-3118
US

V. Phone/Fax

Practice location:
  • Phone: 800-229-5227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License NumberOTHMH1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: