MEDICARE: DR. MOHAMMED TASHFIQUL ISLAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	315847	NY
2	2084P0800X	Psychiatry Physician	57492	KY
3	2084P0804X	Child & Adolescent Psychiatry Physician	57492	KY

General Provider Information

NPI Number	:	1033643960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOHAMMED TASHFIQUL ISLAM M.D.

Provider Business Mailing Address
First Line	:	109 W 27TH ST RM 5S
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-6208
Country	:	US
Telephone Number	:	833-351-8255
Fax Number	:	888-815-3583

Provider Business Practice Location Address
First Line	:	310 S LIMESTONE
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40536-4142
Country	:	US
Telephone Number	:	859-226-7063
Fax Number	:	859-226-7266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	06/18/2025

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