Provider Demographics
NPI:1811357742
Name:BHUIYAN, DIDER HOSSAIN
Entity type:Individual
Prefix:
First Name:DIDER
Middle Name:HOSSAIN
Last Name:BHUIYAN
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 1:16832 GOTHIC DR
Mailing Address - Street 2:3RD FLOORD
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2044
Mailing Address - Country:US
Mailing Address - Phone:239-634-5057
Mailing Address - Fax:239-267-7155
Practice Address - Street 1:250 ROUTE 59
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5315
Practice Address - Country:US
Practice Address - Phone:845-368-4682
Practice Address - Fax:845-368-4694
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050402-1183500000X
FLPS 34782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050402-1OtherPHARMACIST STATE LICENSE NUMBER
FLPS0034782OtherPHARMACIST STATE LICENSE NUMBER