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General NPI Number Information
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NPI Number | 1811357742
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Entity Type | Individual
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Provider Name | DIDER HOSSAIN BHUIYAN
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Gender | Male
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Dates
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Enumeration Date | 03/04/2016
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Last Update Date | 05/14/2016
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Provider Practice Location Address
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Address Line | 250 ROUTE 59
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City | SUFFERN
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State | NY
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Zip | 10901-5315
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Country | US
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Telephone | 845-368-4682
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Fax | 845-368-4694
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Provider Business Mailing Address
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Address Line | 16832 GOTHIC DR 3RD FLOORD
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City | JAMAICA
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State | NY
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Zip | 11432-2044
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Country | US
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Telephone | 239-634-5057
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Fax | 239-267-7155
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 050402-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS 34782
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License Number State | FL
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