Healthcare Provider Details

I. General information

NPI: 1063767416
Provider Name (Legal Business Name): NAEEM RAHMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 MARCUS AVE DEPARTMENT OF RADIOLOGY
NEW HYDE PARK NY
11042-1113
US

IV. Provider business mailing address

2800 MARCUS AVE DEPARTMENT OF RADIOLOGY
NEW HYDE PARK NY
11042-1113
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-6100
  • Fax:
Mailing address:
  • Phone: 516-622-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number275259-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: