Healthcare Provider Details

I. General information

NPI: 1598633414
Provider Name (Legal Business Name): MD SAIFUL ISLAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4922 30TH AVE
WOODSIDE NY
11377-7959
US

IV. Provider business mailing address

2839 VALENTINE AVE APT 1C
BRONX NY
10458-3133
US

V. Phone/Fax

Practice location:
  • Phone: 646-427-4867
  • Fax:
Mailing address:
  • Phone: 646-427-4867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: