Provider Demographics
NPI:1922524677
Name:KAZI-ISLAM, TAHSIN
Entity Type:Individual
Prefix:
First Name:TAHSIN
Middle Name:
Last Name:KAZI-ISLAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAHSIN
Other - Middle Name:
Other - Last Name:KAZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, RDN, CDN
Mailing Address - Street 1:41 KEW GARDENS RD APT 5E
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1112
Mailing Address - Country:US
Mailing Address - Phone:917-456-2389
Mailing Address - Fax:
Practice Address - Street 1:41 KEW GARDENS RD
Practice Address - Street 2:APT 5E
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415
Practice Address - Country:US
Practice Address - Phone:917-456-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008797133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered