Provider Demographics
NPI:1134212558
Name:MIAH, ASADUR RAHMAN (DO)
Entity type:Individual
Prefix:DR
First Name:ASADUR
Middle Name:RAHMAN
Last Name:MIAH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1575 HILLSIDE AVE
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2501
Mailing Address - Country:US
Mailing Address - Phone:516-775-7112
Mailing Address - Fax:516-775-9019
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2501
Practice Address - Country:US
Practice Address - Phone:516-775-7112
Practice Address - Fax:516-775-9019
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200941207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NYG33466Medicare UPIN
NY00246075Medicaid