Provider Demographics
NPI:1972684884
Name:RAHMAN, QUAZI M
Entity Type:Individual
Prefix:
First Name:QUAZI
Middle Name:M
Last Name:RAHMAN
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 1:3526 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2321
Mailing Address - Country:US
Mailing Address - Phone:718-482-7444
Mailing Address - Fax:
Practice Address - Street 1:3526 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2321
Practice Address - Country:US
Practice Address - Phone:718-482-7444
Practice Address - Fax:718-784-3279
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01590656Medicaid
NY015591Medicare PIN
NY07870GMedicare PIN
NYG18736Medicare UPIN
110121891Medicare PIN