Provider Demographics
NPI:1033738414
Name:SAMINA HAQUE DMD PLLC
Entity Type:Organization
Organization Name:SAMINA HAQUE DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-343-0900
Mailing Address - Street 1:119 INGRAHAM LN
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4275
Mailing Address - Country:US
Mailing Address - Phone:646-884-4094
Mailing Address - Fax:
Practice Address - Street 1:25012 HILLSIDE AVE STE A
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-2139
Practice Address - Country:US
Practice Address - Phone:718-343-0900
Practice Address - Fax:718-343-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02709066Medicaid