Provider Demographics
NPI:1346325263
Name:ISLAM, MOHAMMAD MAHBUBUL (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:MAHBUBUL
Last Name:ISLAM
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 1:10 LITTLE BRITAIN RD
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5100
Mailing Address - Country:US
Mailing Address - Phone:845-562-1900
Mailing Address - Fax:845-562-2100
Practice Address - Street 1:10 LITTLE BRITAIN RD
Practice Address - Street 2:SUITE # 102
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5100
Practice Address - Country:US
Practice Address - Phone:845-562-1900
Practice Address - Fax:845-562-2100
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240670207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine