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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 CHURCH AVE
BROOKLYN NY
11218-2207
US

IV. Provider business mailing address

5420 15TH AVE 6H
BROOKLYN NY
11219-4352
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 TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) 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