=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043620040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABIR RAHMAN D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2014
-----------------------------------------------------
Last Update Date | 02/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 263 FARMINGTON AVENUE
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06030-8031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-679-4888
-----------------------------------------------------
Fax | 860-679-1462
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 263 FARMINGTON AVENUE
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06030-8031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-679-4888
-----------------------------------------------------
Fax | 860-679-1462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 25MB10358300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 5101022077
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2081N0008X
-----------------------------------------------------
Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 306868
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2081N0008X
-----------------------------------------------------
Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 71185
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 5101022077
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 71185
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------