Individual
MUBUSHAR IKRAM RAZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
55 2ND AVE UNIT 2, BRENTWOOD, NY 11717-4665
(631) 983-3237
(631) 961-8775
Mailing address
55 2ND AVE UNIT 2, BRENTWOOD, NY 11717-4665
(631) 983-3273
(631) 961-8775
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
307814
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
307814
307814
NY
Enumeration date
07/19/2016
Last updated
01/23/2026
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