Basic Information
| Provider Information | |||||||||
| NPI: | 1407083454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAHMAN | ||||||||
| FirstName: | WASIQ | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 E MAIN ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117723114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316543278 | ||||||||
| FaxNumber: | 6316541474 | ||||||||
| Practice Location | |||||||||
| Address1: | 325 E MAIN ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117723114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316543278 | ||||||||
| FaxNumber: | 6316541474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2009 | ||||||||
| LastUpdateDate: | 04/03/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD446120 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 287686 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.