Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 121552 | NY |
NPI | 1295988814 |
---|---|
Provider Name | Dr. Abu M.r Islam |
First Address | East Elmhurst, NY 11370-1823 |
Second Address | East Elmhurst, NY 11370-1823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 28/10/2008 |