Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 034129 | NY |
NPI | 1437132040 |
---|---|
Provider Name | Mr. Mohammad Motasim Billah |
First Address | Brooklyn, NY 11211-7308 |
Second Address | Brooklyn, NY 11211-7308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 26/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00374841 | (05) | NY |