Provider Demographics
NPI:1851759799
Name:MUHIDDIN, ABU BARKALLE
Entity Type:Individual
Prefix:
First Name:ABU
Middle Name:BARKALLE
Last Name:MUHIDDIN
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 1:1039 EMERSON ST APT C
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-2746
Mailing Address - Country:US
Mailing Address - Phone:585-642-5896
Mailing Address - Fax:
Practice Address - Street 1:1039 EMERSON ST APT C
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-2746
Practice Address - Country:US
Practice Address - Phone:585-642-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-07
Last Update Date:2016-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY502491734344600000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
No347C00000XTransportation ServicesPrivate Vehicle