Provider Demographics
NPI:1295176568
Name:RAHMAN, OPU M (PA)
Entity type:Individual
Prefix:MR
First Name:OPU
Middle Name:M
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:3018 BARNES AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8577
Mailing Address - Country:US
Mailing Address - Phone:347-503-9138
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363AS0400X
NY016673363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical