Healthcare Provider Details

I. General information

NPI: 1487480810
Provider Name (Legal Business Name): TOPAZ MEDICAL OF NEW YORK PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON MALL # 1341
BOSTON MA
02108-2616
US

IV. Provider business mailing address

1 WASHINGTON MALL # 1341
BOSTON MA
02108-2616
US

V. Phone/Fax

Practice location:
  • Phone: 970-618-4426
  • Fax:
Mailing address:
  • Phone: 970-618-4426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SABA HAQ
Title or Position: PRESIDENT
Credential: MD
Phone: 949-463-0650