Healthcare Provider Details

I. General information

NPI: 1083355283
Provider Name (Legal Business Name): MARIAM KHALIL RAHMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 MADISON AVE
NEW YORK NY
10029-6514
US

IV. Provider business mailing address

2536 90TH ST
EAST ELMHURST NY
11369-1708
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8752
  • Fax:
Mailing address:
  • Phone: 718-427-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: