1477688455 NPI number — MOHAMMAD RAFIQUL ISLAM

Table of content: BENJAMIN MATTHEW VIERRA MD (NPI 1558010199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477688455 NPI number — MOHAMMAD RAFIQUL ISLAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISLAM
Provider First Name:
MOHAMMAD
Provider Middle Name:
RAFIQUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477688455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 FOXHURST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIX HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11746-4619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-549-1616
Provider Business Mailing Address Fax Number:
631-549-1904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8119 41ST AVE
Provider Second Line Business Practice Location Address:
RUBEX DRUGS INC
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11373-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-397-0776
Provider Business Practice Location Address Fax Number:
718-898-8705
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  037911 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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