Healthcare Provider Details

I. General information

NPI: 1164735650
Provider Name (Legal Business Name): SOHAIL QAYYUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

703 MAIN ST
PATERSON NJ
07503-2621
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-3510
  • Fax: 973-754-3292
Mailing address:
  • Phone: 973-754-2000
  • Fax: 973-754-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA11126600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: