Provider Demographics
NPI:1154127900
Name:MOLLAH, QAMRUZZAMAN
Entity type:Individual
Prefix:
First Name:QAMRUZZAMAN
Middle Name:
Last Name:MOLLAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 TWIN OAKS DR APT 210
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-5018
Mailing Address - Country:US
Mailing Address - Phone:215-900-8989
Mailing Address - Fax:
Practice Address - Street 1:115 TWIN OAKS DR APT 210
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-5018
Practice Address - Country:US
Practice Address - Phone:215-900-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician