Provider Demographics
NPI:1295988814
Name:ISLAM, ABU MR (MD)
Entity type:Individual
Prefix:DR
First Name:ABU
Middle Name:MR
Last Name:ISLAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 76TH ST
Mailing Address - Street 2:FIRST FL
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1823
Mailing Address - Country:US
Mailing Address - Phone:718-424-4211
Mailing Address - Fax:
Practice Address - Street 1:3108 76TH ST
Practice Address - Street 2:FIRST FL
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1823
Practice Address - Country:US
Practice Address - Phone:718-424-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121552207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine