Provider Demographics
NPI:1790268514
Name:HUMAYUN RASHID PHYSICIAN PC
Entity Type:Organization
Organization Name:HUMAYUN RASHID PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YEKATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-266-3413
Mailing Address - Street 1:3514 MERMAID AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-1508
Mailing Address - Country:US
Mailing Address - Phone:718-266-3413
Mailing Address - Fax:
Practice Address - Street 1:3514 MERMAID AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1508
Practice Address - Country:US
Practice Address - Phone:718-266-3413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9553207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00832595Medicaid