Healthcare Provider Details

I. General information

NPI: 1407957863
Provider Name (Legal Business Name): INAM UL HAQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 50TH ST
BROOKLYN NY
11219-3309
US

IV. Provider business mailing address

966 50TH ST
BROOKLYN NY
11219-3309
US

V. Phone/Fax

Practice location:
  • Phone: 718-435-1831
  • Fax: 718-435-2748
Mailing address:
  • Phone: 718-435-1831
  • Fax: 718-435-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number119722
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: