Provider Demographics
NPI:1679026173
Name:BILLAH, AHASAN
Entity Type:Individual
Prefix:
First Name:AHASAN
Middle Name:
Last Name:BILLAH
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 1:2435 96TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-1213
Mailing Address - Country:US
Mailing Address - Phone:718-290-6630
Mailing Address - Fax:516-570-6224
Practice Address - Street 1:2435 96TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11369-1213
Practice Address - Country:US
Practice Address - Phone:718-290-6630
Practice Address - Fax:516-570-6224
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5203628343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)