Provider Demographics
NPI:1750886321
Name:RAHMAN, SUBHANA A (LPN)
Entity type:Individual
Prefix:
First Name:SUBHANA
Middle Name:A
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 ALLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5927
Mailing Address - Country:US
Mailing Address - Phone:718-710-9559
Mailing Address - Fax:212-666-1679
Practice Address - Street 1:1512 ALLERTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5927
Practice Address - Country:US
Practice Address - Phone:718-710-9559
Practice Address - Fax:212-666-1679
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304437164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$Medicaid