Provider Demographics
NPI:1629279591
Name:RAHMAN, MOHAMMED S (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:S
Last Name:RAHMAN
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 1:7515 GLENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1025
Mailing Address - Country:US
Mailing Address - Phone:718-845-0081
Mailing Address - Fax:718-845-0081
Practice Address - Street 1:260 PATCHOGUE YAPHANK RD
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4886
Practice Address - Country:US
Practice Address - Phone:631-654-8755
Practice Address - Fax:631-654-8709
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233199207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
W38231OtherMEDICARE GROUP NUMBER
NY01891670Medicaid
028SU38231Medicare PIN
W38231OtherMEDICARE GROUP NUMBER