Provider Demographics
NPI:1760015051
Name:ISLAM, MD ARIFUL
Entity Type:Individual
Prefix:
First Name:MD
Middle Name:ARIFUL
Last Name:ISLAM
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 1:22004 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1621
Mailing Address - Country:US
Mailing Address - Phone:718-712-3358
Mailing Address - Fax:888-352-0588
Practice Address - Street 1:3427 STEINWAY ST STE 301
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-8602
Practice Address - Country:US
Practice Address - Phone:212-996-2200
Practice Address - Fax:888-352-0588
Is Sole Proprietor?:No
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator