Provider Demographics
NPI:1316205586
Name:MAHMUD, MAINUDDIN AL
Entity type:Individual
Prefix:MR
First Name:MAINUDDIN
Middle Name:AL
Last Name:MAHMUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1896 ROUTE 6
Mailing Address - Street 2:PUTNAM PLAZA
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 ROUTE 59
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2913
Practice Address - Country:US
Practice Address - Phone:845-358-1589
Practice Address - Fax:845-353-2673
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI053772-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist