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General NPI Number Information
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NPI Number | 1114204740
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Entity Type | Individual
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Provider Name | NASHID ISLAM PA
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Gender | Male
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 12/15/2022
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Provider Practice Location Address
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Address Line | 86-13 91AVENUE
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City | WOODHAVEN
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State | NY
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Zip | 11421
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Country | US
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Telephone | 917-495-2398
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Fax |
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Provider Business Mailing Address
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Address Line | 27 WILLIAM ST
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City | VALLEY STREAM
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State | NY
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Zip | 11580-1029
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Country | US
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Telephone | 917-495-2398
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 015302
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License Number State | NY
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