Provider Demographics
NPI:1609807320
Name:WOODHAVEN MEDICAL, P.C.
Entity Type:Organization
Organization Name:WOODHAVEN MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-441-2640
Mailing Address - Street 1:89-12 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421
Mailing Address - Country:US
Mailing Address - Phone:718-441-2640
Mailing Address - Fax:718-846-0904
Practice Address - Street 1:89-12 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421
Practice Address - Country:US
Practice Address - Phone:718-441-2640
Practice Address - Fax:718-846-0904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty