Provider Demographics
NPI:1962940445
Name:NURUZZAMAN, MD
Entity type:Individual
Prefix:
First Name:MD
Middle Name:
Last Name:NURUZZAMAN
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 1:10515 77TH ST
Mailing Address - Street 2:FL 2
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1010
Mailing Address - Country:US
Mailing Address - Phone:718-509-7057
Mailing Address - Fax:
Practice Address - Street 1:10515 77TH ST
Practice Address - Street 2:FL 2
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1010
Practice Address - Country:US
Practice Address - Phone:718-509-7057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist