Provider Demographics
NPI:1194811521
Name:RAHMAN, MOHAMMED M (MD)
Entity type:Individual
Prefix:MR
First Name:MOHAMMED
Middle Name:M
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1200
Mailing Address - Country:US
Mailing Address - Phone:718-674-6222
Mailing Address - Fax:
Practice Address - Street 1:8834 161ST ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4040
Practice Address - Country:US
Practice Address - Phone:718-674-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01771104Medicaid
NY01005JMedicare ID - Type Unspecified
NY01771104Medicaid