Provider Demographics
NPI:1417278904
Name:BARI, MOHAMMED FAZLUL (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:FAZLUL
Last Name:BARI
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 1:8502 169TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2630
Mailing Address - Country:US
Mailing Address - Phone:917-519-6980
Mailing Address - Fax:
Practice Address - Street 1:8502 169TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2630
Practice Address - Country:US
Practice Address - Phone:917-519-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty