Healthcare Provider Details

I. General information

NPI: 1710807409
Provider Name (Legal Business Name): NY MIND BODY NP IN PSYCHIATRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CASTLE HILL AVE # 1055
BRONX NY
10462-4399
US

IV. Provider business mailing address

3325 69TH ST
WOODSIDE NY
11377-2239
US

V. Phone/Fax

Practice location:
  • Phone: 718-973-3943
  • Fax:
Mailing address:
  • Phone: 718-973-3943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: FATEMA S SADEQUE-IQBAL
Title or Position: PRESIDENT
Credential: NP
Phone: 718-973-3943