Healthcare Provider Details

I. General information

NPI: 1164593851
Provider Name (Legal Business Name): MIR JAVED IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4277 HEMPSTEAD TPK SUITE 107
BETHPAGE NY
11714
US

IV. Provider business mailing address

4277 HEMPSTEAD TPK SUITE 107
BETHPAGE NY
11714
US

V. Phone/Fax

Practice location:
  • Phone: 516-735-9210
  • Fax: 516-735-9247
Mailing address:
  • Phone: 516-735-9210
  • Fax: 516-735-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number138686
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: