1306525316 NPI number — WARDAH MATEEN RPH

Table of content: WARDAH MATEEN RPH (NPI 1306525316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306525316 NPI number — WARDAH MATEEN RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATEEN
Provider First Name:
WARDAH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

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:
1306525316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
53 UNION AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEER PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11729-3121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-547-4423
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5369 KINGS HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-6704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-203-6282
Provider Business Practice Location Address Fax Number:
929-474-9097
Provider Enumeration Date:
07/17/2023

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:  070410 , 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)

  • Identifier: 070410 . This is a "NEW YORK STATE BOARD OF EDUCATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".