Basic Information
| Provider Information | |||||||||
| NPI: | 1649878604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RASUL | ||||||||
| FirstName: | TABRAIZ | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 EILEEN WAY UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117915313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168555255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3457 NOSTRAND AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112295131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186151100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2020 | ||||||||
| LastUpdateDate: | 10/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | P105264 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.