Provider Demographics
NPI:1588752752
Name:S.K. BHUIYAN PHYSICIAN, PC
Entity type:Organization
Organization Name:S.K. BHUIYAN PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-200-0723
Mailing Address - Street 1:1100 SHAMES DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1765
Mailing Address - Country:US
Mailing Address - Phone:516-693-0700
Mailing Address - Fax:516-693-0271
Practice Address - Street 1:4024 76TH ST STE 1AB
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1009
Practice Address - Country:US
Practice Address - Phone:718-812-7866
Practice Address - Fax:516-706-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2023-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206889-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01765177Medicaid
NYWEL211Medicare PIN
NY01765177Medicaid