Provider Demographics
NPI:1982885224
Name:BADRUL, MOMANA NASRIN (RPH)
Entity Type:Individual
Prefix:
First Name:MOMANA
Middle Name:NASRIN
Last Name:BADRUL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 23RD RD FL 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1519
Mailing Address - Country:US
Mailing Address - Phone:718-726-9510
Mailing Address - Fax:646-486-0635
Practice Address - Street 1:534 HUDSON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-6114
Practice Address - Country:US
Practice Address - Phone:646-486-1048
Practice Address - Fax:646-486-0635
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02043754Medicaid