Healthcare Provider Details

I. General information

NPI: 1487703401
Provider Name (Legal Business Name): MASOOM H. QADEER, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 01/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1993 DEER PARK AVE
DEER PARK NY
11729-2719
US

IV. Provider business mailing address

460 HALF HOLLOW RD
DIX HILLS NY
11746-5829
US

V. Phone/Fax

Practice location:
  • Phone: 631-242-7246
  • Fax: 631-242-4907
Mailing address:
  • Phone: 631-242-7246
  • Fax: 631-242-4097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MASOOM H QADEER
Title or Position: OWNER
Credential: M.D.
Phone: 631-242-7246