Provider Demographics
NPI:1134585797
Name:ABDUR-RAHMAN, BADRIYAH (RN)
Entity type:Individual
Prefix:
First Name:BADRIYAH
Middle Name:
Last Name:ABDUR-RAHMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 HANCOCK ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1367
Mailing Address - Country:US
Mailing Address - Phone:718-271-8383
Mailing Address - Fax:718-271-4389
Practice Address - Street 1:10525 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4534
Practice Address - Country:US
Practice Address - Phone:718-576-4768
Practice Address - Fax:718-271-7196
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY596208163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse