Healthcare Provider Details

I. General information

NPI: 1538803317
Provider Name (Legal Business Name): DILRUBA ISLAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86-23 131 STREET
RICHMOND HILL NY
11418
US

IV. Provider business mailing address

2975 INDEPENDENCE AVE
BRONX NY
10463-4620
US

V. Phone/Fax

Practice location:
  • Phone: 718-916-6177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP114711
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberP114711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: