Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 262043 | NY |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 262043 | NY |
NPI | 1043473424 |
---|---|
Provider Name | Brad A Rahaman |
First Address | Brooklyn, NY 11203-1809 |
Second Address | Brooklyn, NY 11203-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 11/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FR2693643 | DEA (01) | NY |