Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 228779-01 | NY |
NPI | 1154497865 |
---|---|
Provider Name | Dr. Mohammad Quamruzzaman |
First Address | Flushing, NY 11367-2925 |
Second Address | Jamaica, NY 11432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02583806 | (05) | NY |
I19523 | (02) | NY |