Healthcare Provider Details

I. General information

NPI: 1700811973
Provider Name (Legal Business Name): SYEDQAMBAR RAZA NAQVI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 LOUDEN AVENUE
AMITYVILLE NY
11701-0000
US

IV. Provider business mailing address

125 BLYDENBURG AVENUE
SMITHTOWN NY
11787-0000
US

V. Phone/Fax

Practice location:
  • Phone: 631-789-7064
  • Fax: 631-789-7886
Mailing address:
  • Phone: 631-742-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number202988-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: