Provider Demographics
NPI:1346329984
Name:ADAM, MUHAMMAD SANNI (MD PC)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:SANNI
Last Name:ADAM
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:MUHAMMAD
Other - Middle Name:SANNI
Other - Last Name:ADAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:1983 UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4404
Mailing Address - Country:US
Mailing Address - Phone:718-866-0510
Mailing Address - Fax:718-866-0522
Practice Address - Street 1:1983 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4404
Practice Address - Country:US
Practice Address - Phone:718-866-0510
Practice Address - Fax:718-866-0522
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01591602Medicaid
G15628Medicare UPIN
NY752011Medicare ID - Type Unspecified