Provider Demographics
NPI:1427137785
Name:JAMAL, HABIBULLAH (MD)
Entity type:Individual
Prefix:
First Name:HABIBULLAH
Middle Name:
Last Name:JAMAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HABIB
Other - Middle Name:
Other - Last Name:JAMAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:14 RYE RIDGE PLAZA SUITE
Mailing Address - Street 2:247
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573
Mailing Address - Country:US
Mailing Address - Phone:914-253-4985
Mailing Address - Fax:914-253-4988
Practice Address - Street 1:14 RYE RIDGE PLZ STE 247
Practice Address - Street 2:
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2858
Practice Address - Country:US
Practice Address - Phone:914-253-4985
Practice Address - Fax:914-253-4988
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY128157207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00557053Medicaid
132692290OtherTIN
132692290OtherTIN
NY00557053Medicaid