Individual
A S M TAZUL ISLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9131 175TH ST, JAMAICA, NY 11432-5517
(718) 657-6363
Mailing address
17810 WEXFORD TER APT 4R, JAMAICA, NY 11432-3014
(347) 820-5051
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
104094
NY
Other
Enumeration date
01/28/2020
Last updated
01/28/2020
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