Healthcare Provider Details

I. General information

NPI: 1528147451
Provider Name (Legal Business Name): ANJUM A HAQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1384 BROADWAY ST
BUFFALO NY
14212-1808
US

IV. Provider business mailing address

1384 BROADWAY ST
BUFFALO NY
14212-1808
US

V. Phone/Fax

Practice location:
  • Phone: 716-894-9672
  • Fax:
Mailing address:
  • Phone: 716-894-9672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number224186
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: