Healthcare Provider Details

I. General information

NPI: 1306880547
Provider Name (Legal Business Name): KHONDEKER M. RAHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 PARK AVE
WILLISTON PARK NY
11596-1135
US

IV. Provider business mailing address

278 PARK AVE
WILLISTON PARK NY
11596-1135
US

V. Phone/Fax

Practice location:
  • Phone: 516-304-0008
  • Fax:
Mailing address:
  • Phone: 516-304-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number238298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: