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General NPI Number Information
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NPI Number | 1578945341
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Entity Type | Individual
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Provider Name | AYESHA MOHIUDDIN DPM
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Gender | Female
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Dates
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Enumeration Date | 06/29/2015
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Last Update Date | 06/29/2015
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Provider Practice Location Address
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Address Line | 25 WASHINGTON AVE UNIT 2
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City | LYNBROOK
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State | NY
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Zip | 11563-2723
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Country | US
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Telephone | 630-945-6016
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Fax |
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Provider Business Mailing Address
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Address Line | 25 WASHINGTON AVE UNIT 2
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City | LYNBROOK
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State | NY
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Zip | 11563-2723
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Country | US
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Telephone |
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00324000
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License Number State | NJ
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