Provider Demographics
NPI:1275808727
Name:ABDUR-RASHEED, IHSAN
Entity Type:Individual
Prefix:
First Name:IHSAN
Middle Name:
Last Name:ABDUR-RASHEED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 POLK CT
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3915
Mailing Address - Country:US
Mailing Address - Phone:631-732-0787
Mailing Address - Fax:631-732-0787
Practice Address - Street 1:13 POLK CT
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3915
Practice Address - Country:US
Practice Address - Phone:631-732-0787
Practice Address - Fax:631-732-0787
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307858-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse