Provider Demographics
NPI:1386999035
Name:UDDIN, MAIN (FNP)
Entity type:Individual
Prefix:MR
First Name:MAIN
Middle Name:
Last Name:UDDIN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:169-59 137TH AVE
Practice Address - Street 2:
Practice Address - City:ROCHDALE
Practice Address - State:NY
Practice Address - Zip Code:11434-4517
Practice Address - Country:US
Practice Address - Phone:718-525-5600
Practice Address - Fax:718-559-5285
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily