Provider Demographics
NPI:1952679649
Name:HOSSAIN, TANBIR
Entity Type:Individual
Prefix:MR
First Name:TANBIR
Middle Name:
Last Name:HOSSAIN
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 1:11517 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1901
Mailing Address - Country:US
Mailing Address - Phone:718-641-4400
Mailing Address - Fax:718-641-4401
Practice Address - Street 1:11517 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1901
Practice Address - Country:US
Practice Address - Phone:718-641-4400
Practice Address - Fax:718-641-4401
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY453645310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist