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General NPI Number Information
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NPI Number | 1801605761
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Entity Type | Organization
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Legal Business Name | STATION CARE NP IN ADULT HEALTH PC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 55 2ND AVE UNIT 2
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City | BRENTWOOD
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State | NY
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Zip | 11717-4665
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Country | US
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Telephone | 631-983-3237
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Fax | 631-961-8775
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Provider Business Mailing Address
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Address Line | 55 2ND AVE UNIT 2
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City | BRENTWOOD
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State | NY
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Zip | 11717-4665
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Country | US
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Telephone | 631-983-3237
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Fax | 631-961-8775
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MUBUSHAR IKRAM RAZA
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Credential | NURSE PRACTITIONER
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Telephone | 631-983-3237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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