Provider Demographics
NPI:1235169657
Name:RAHMAN, MONZILA HASSEN (MD)
Entity Type:Individual
Prefix:
First Name:MONZILA
Middle Name:HASSEN
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 77TH ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6630
Mailing Address - Country:US
Mailing Address - Phone:718-672-9310
Mailing Address - Fax:718-672-9311
Practice Address - Street 1:2 BROOKDALE CT
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1962
Practice Address - Country:US
Practice Address - Phone:347-573-1322
Practice Address - Fax:718-672-9311
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240237207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02799806Medicaid
NYG40052885Medicare PIN
NYG100052880Medicare PIN