MEDICARE: BURHAN IMTIAZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	073785	NY

General Provider Information

NPI Number	:	1093662405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BURHAN IMTIAZ

Provider Business Mailing Address
First Line	:	963 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-8872
Country	:	US
Telephone Number	:	347-374-2627
Fax Number	:

Provider Business Practice Location Address
First Line	:	963 BROADWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-8872
Country	:	US
Telephone Number	:	347-374-2627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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Directions to “ BURHAN IMTIAZ ” Practice Location

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