Healthcare Provider Details

I. General information

NPI: 1457410607
Provider Name (Legal Business Name): MASOOM REHAB MEDICAL OFFICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 CHURCH AVE
BROOKLYN NY
11218-2207
US

IV. Provider business mailing address

17 CORTLAND CT
HUNTINGTON STATION NY
11746-4309
US

V. Phone/Fax

Practice location:
  • Phone: 646-287-9406
  • Fax: 718-504-7966
Mailing address:
  • Phone: 646-287-9406
  • Fax: 718-504-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMAD ASIF IQBAL
Title or Position: OWNER
Credential: M.D.
Phone: 646-287-9406