Provider Demographics
NPI:1831823392
Name:FERDUSH, JANNATUL
Entity type:Individual
Prefix:
First Name:JANNATUL
Middle Name:
Last Name:FERDUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 88TH ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1423
Mailing Address - Country:US
Mailing Address - Phone:347-859-0880
Mailing Address - Fax:
Practice Address - Street 1:10730 88TH ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1423
Practice Address - Country:US
Practice Address - Phone:347-859-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12345678Medicaid