Healthcare Provider Details

I. General information

NPI: 1790362630
Provider Name (Legal Business Name): REEMA MARIAM IQBAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E PUTNAM AVE
COS COB CT
06807-2600
US

IV. Provider business mailing address

5085 MAIN ST APT 4306
TRUMBULL CT
06611-5905
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number78969
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number330959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: