Healthcare Provider Details

I. General information

NPI: 1396521696
Provider Name (Legal Business Name): MASOOD UR RAHMAN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

288 KISSEL AVENUE APT 5 G
STATEN ISLAND NY
10310
US

IV. Provider business mailing address

SHEIKH SHAKHBOUT MEDICAL CITY
ABU DHABI ABU DHABI
11010
AE

V. Phone/Fax

Practice location:
  • Phone: 929-542-7963
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberT2519
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: