Provider Demographics
NPI:1730310061
Name:MARUF, MOHAMMAD GOLAM (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:GOLAM
Last Name:MARUF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 MARCUS DR
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4230
Mailing Address - Country:US
Mailing Address - Phone:631-391-7887
Mailing Address - Fax:631-454-4163
Practice Address - Street 1:8900 VAN WYCK EXPY
Practice Address - Street 2:TJH MEDICAL SERVICES, P.C.
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418-2832
Practice Address - Country:US
Practice Address - Phone:718-206-6768
Practice Address - Fax:718-206-6651
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY254129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine