MEDICARE: ABU BARKALLE MUHIDDIN

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	344600000X	Taxi	502491734	NY
2	347C00000X	Private Vehicle	502491734	NY

General Provider Information

NPI Number	:	1851759799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABU BARKALLE MUHIDDIN

Provider Business Mailing Address
First Line	:	1039 EMERSON ST APT C
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14606-2746
Country	:	US
Telephone Number	:	585-642-5896
Fax Number	:

Provider Business Practice Location Address
First Line	:	1039 EMERSON ST APT C
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14606-2746
Country	:	US
Telephone Number	:	585-642-5896
Fax Number	:

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

Provider Enumeration Date	:	02/07/2016
Last Update Date	:	02/07/2016

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