Provider Demographics
NPI:1720574346
Name:BILLAH, MD MASUD (MD)
Entity Type:Individual
Prefix:
First Name:MD MASUD
Middle Name:
Last Name:BILLAH
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 1:275 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-8012
Mailing Address - Country:US
Mailing Address - Phone:646-642-7029
Mailing Address - Fax:
Practice Address - Street 1:275 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-8012
Practice Address - Country:US
Practice Address - Phone:646-642-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP11365207R00000X
NY317519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty