Provider Demographics
NPI:1407012677
Name:ABEDIN, JAHIDUL (MD)
Entity Type:Individual
Prefix:
First Name:JAHIDUL
Middle Name:
Last Name:ABEDIN
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 1:1 EXECUTIVE CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5003
Mailing Address - Country:US
Mailing Address - Phone:718-313-0822
Mailing Address - Fax:631-546-7515
Practice Address - Street 1:7036 BROADWAY
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6113
Practice Address - Country:US
Practice Address - Phone:718-313-0822
Practice Address - Fax:631-546-7515
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255429208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03187895Medicaid