Provider Demographics
NPI:1558648162
Name:KHUNDKAR, MAHBUB ZAMAN (RPH)
Entity Type:Individual
Prefix:
First Name:MAHBUB
Middle Name:ZAMAN
Last Name:KHUNDKAR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-4535
Mailing Address - Country:US
Mailing Address - Phone:786-252-3357
Mailing Address - Fax:
Practice Address - Street 1:4504 GREENPOINT AVENUE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104
Practice Address - Country:US
Practice Address - Phone:917-396-4944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42320183500000X
NY061616-1183500000X
NJ28RI03404200183500000X
MD18649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist