Healthcare Provider Details

I. General information

NPI: 1134877616
Provider Name (Legal Business Name): TOHIDUL ISLAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W 41ST ST FL 15
NEW YORK NY
10036-7207
US

IV. Provider business mailing address

4109 15TH AVE APT C1
BROOKLYN NY
11219-1549
US

V. Phone/Fax

Practice location:
  • Phone: 332-249-1842
  • Fax:
Mailing address:
  • Phone: 347-557-3986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number063375
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: