Healthcare Provider Details

I. General information

NPI: 1497077812
Provider Name (Legal Business Name): NAQIY MEDICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 GRAND CONCOURSE
BRONX NY
10458-1213
US

IV. Provider business mailing address

3130 GRAND CONCOURSE
BRONX NY
10458-1213
US

V. Phone/Fax

Practice location:
  • Phone: 516-659-0967
  • Fax:
Mailing address:
  • Phone: 516-659-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number116662
License Number StateNY

VIII. Authorized Official

Name: DR. SAMUEL WALTERS
Title or Position: OWNER
Credential: M.D.
Phone: 515-659-0967