1588752752 NPI number — S.K. BHUIYAN PHYSICIAN, PC

Table of content: (NPI 1588752752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588752752 NPI number — S.K. BHUIYAN PHYSICIAN, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S.K. BHUIYAN PHYSICIAN, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1588752752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 SHAMES DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WESTBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11590-1765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-693-0700
Provider Business Mailing Address Fax Number:
516-693-0271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4024 76TH ST STE 1AB
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11373-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-812-7866
Provider Business Practice Location Address Fax Number:
516-706-6026
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOMEN
Authorized Official First Name:
MUHAMMAD
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
718-200-0723

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  206889-1 , 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: 01765177 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com