Provider Demographics
NPI:1639108137
Name:ABDULLAH, GHAZANFAR SYED (MD)
Entity Type:Individual
Prefix:DR
First Name:GHAZANFAR
Middle Name:SYED
Last Name:ABDULLAH
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 1:1 DEER PARK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-1808
Mailing Address - Country:US
Mailing Address - Phone:718-369-7313
Mailing Address - Fax:718-369-7317
Practice Address - Street 1:108 E 183RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-1237
Practice Address - Country:US
Practice Address - Phone:718-295-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02L451Medicare ID - Type Unspecified