Dr. Tajul Islam DDS PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

050581 Issued in NY

Legal business name

DR. TAJUL ISLAM DDS PC

Practice address

1236 Fulton St
Brooklyn, NY 11216-2093

Phone

(718) 622-1868

NPI assigned

Jul 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tajul Islam, D.D.S.

Title

President

Phone

(718) 622-1868

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184112000000",
    "number": "1558569582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1236 FULTON ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112162093",
            "telephone_number": "718-622-1868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 FULTON ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112162093",
            "telephone_number": "718-622-1868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. TAJUL ISLAM DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-11",
        "last_updated": "2007-07-11",
        "status": "A",
        "authorized_official_last_name": "ISLAM",
        "authorized_official_first_name": "TAJUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-622-1868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NY",
            "license": "050581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORAL DENTAL IPA OF NEW Y",
            "identifier": "9179252",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02392501",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dental Clinic/Center in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Dental Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.