Provider Demographics
NPI:1093877821
Name:RAHMAN, MUHIBUR (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:MUHIBUR
Middle Name:
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 67TH ST
Mailing Address - Street 2:APT#2R
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-8507
Mailing Address - Country:US
Mailing Address - Phone:718-429-3304
Mailing Address - Fax:
Practice Address - Street 1:4023 67TH ST
Practice Address - Street 2:2R
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-8507
Practice Address - Country:US
Practice Address - Phone:718-429-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010995363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant