Provider Demographics
NPI:1104846765
Name:ULLAH, ASMAT (MD)
Entity Type:Individual
Prefix:DR
First Name:ASMAT
Middle Name:
Last Name:ULLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 ROUTE 112 BLDG 4
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-8055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5425
Practice Address - Country:US
Practice Address - Phone:718-250-8000
Practice Address - Fax:631-509-6559
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39677207P00000X
NY253635207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY020082000OtherDEPARTMENT OF LABOR
KY164134000OtherFEDERAL WORKERS COMP
KY1224922OtherCHA
KY1532292OtherUMWA/FUNDS
KYBU9438830OtherDEA
KY000000477128OtherBLUE CROSS BLUE SHIELD
KY264722OtherATLS
KY64112972Medicaid
KYI44356Medicare UPIN
KY0535542Medicare PIN