Healthcare Provider Details

I. General information

NPI: 1528057684
Provider Name (Legal Business Name): MAFUJUL HASAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 GREENPOINT AVE
SUNNYSIDE NY
11104-3618
US

IV. Provider business mailing address

4014 GREENPOINT AVE
SUNNYSIDE NY
11104-3618
US

V. Phone/Fax

Practice location:
  • Phone: 718-392-2858
  • Fax: 718-392-2752
Mailing address:
  • Phone: 718-392-2858
  • Fax: 718-392-2752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number044293
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: