Provider Demographics
NPI:1902976947
Name:ISLAM, HUMAYUN (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMAYUN
Middle Name:
Last Name:ISLAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 BRENDER LN
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-1970
Mailing Address - Country:US
Mailing Address - Phone:914-962-3024
Mailing Address - Fax:
Practice Address - Street 1:95 GRASSLANDS RD
Practice Address - Street 2:WESTCHESTER MEDICAL CENTER - ANATOMIC PATHOLOGY
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1646
Practice Address - Country:US
Practice Address - Phone:914-493-1072
Practice Address - Fax:914-493-1145
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232392207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI128655Medicare UPIN
NY57R661Medicare ID - Type Unspecified