Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | P112354 | NY |
NPI | 1295499291 |
---|---|
Provider Name | Mohammad Nurunnabi Sarker |
First Address | Ozone Park, NY 11417-1212 |
Second Address | Brooklyn, NY 11208-3220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2021 |
Last Update Date | 26/10/2021 |