Healthcare Provider Details

I. General information

NPI: 1851759799
Provider Name (Legal Business Name): ABU BARKALLE MUHIDDIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2016
Last Update Date: 02/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 EMERSON ST APT C
ROCHESTER NY
14606-2746
US

IV. Provider business mailing address

1039 EMERSON ST APT C
ROCHESTER NY
14606-2746
US

V. Phone/Fax

Practice location:
  • Phone: 585-642-5896
  • Fax:
Mailing address:
  • Phone: 585-642-5896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number502491734
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number502491734
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: