Provider Demographics
NPI:1558701037
Name:UDDIN, ASHFAK
Entity Type:Individual
Prefix:DR
First Name:ASHFAK
Middle Name:
Last Name:UDDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 WHITE PLAINS RD APT 328
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-4921
Mailing Address - Country:US
Mailing Address - Phone:347-381-0597
Mailing Address - Fax:845-344-0076
Practice Address - Street 1:119 WICKHAM AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3714
Practice Address - Country:US
Practice Address - Phone:315-624-6227
Practice Address - Fax:845-344-0076
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY057445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00384309Medicaid