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General NPI Number Information
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NPI Number | 1033643960
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Entity Type | Individual
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Provider Name | MOHAMMED TASHFIQUL ISLAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 310 S LIMESTONE
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City | LEXINGTON
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State | KY
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Zip | 40536-4142
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Country | US
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Telephone | 859-226-7063
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Fax | 859-226-7266
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Provider Business Mailing Address
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Address Line | 109 W 27TH ST RM 5S
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City | NEW YORK
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State | NY
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Zip | 10001-6208
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Country | US
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Telephone | 833-351-8255
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Fax | 888-815-3583
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 315847
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 57492
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 57492
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License Number State | KY
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