Provider Demographics
NPI:1962155093
Name:UDDIN, KHANDAKER EMON
Entity type:Individual
Prefix:
First Name:KHANDAKER
Middle Name:EMON
Last Name:UDDIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10224 217TH LN # 1F
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2000
Mailing Address - Country:US
Mailing Address - Phone:929-344-9185
Mailing Address - Fax:
Practice Address - Street 1:4902 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4444
Practice Address - Country:US
Practice Address - Phone:929-296-6790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-29
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016684101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health