Provider Demographics
NPI:1295499291
Name:SARKER, MOHAMMAD NURUNNABI
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:NURUNNABI
Last Name:SARKER
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 1:8007 SUTTER AVE # 2F
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1212
Mailing Address - Country:US
Mailing Address - Phone:347-659-5378
Mailing Address - Fax:
Practice Address - Street 1:2830 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3220
Practice Address - Country:US
Practice Address - Phone:718-235-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP112354207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine