Provider Demographics
NPI:1114612934
Name:ISLAM, MUHAMMAD SHARIFUL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:SHARIFUL
Last Name:ISLAM
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 BROADWAY # B1-27
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-1419
Mailing Address - Fax:718-334-5006
Practice Address - Street 1:7901 BROADWAY # B1-27
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1329
Practice Address - Country:US
Practice Address - Phone:718-334-1419
Practice Address - Fax:718-334-5006
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF351015363LF0000X
NY2204102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty