Healthcare Provider Details

I. General information

NPI: 1558441584
Provider Name (Legal Business Name): MUSARRAT IQBAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 SILLS ROAD BUILDING 15, SUITE F
EAST PATCHOGUE NY
11772
US

IV. Provider business mailing address

250 PATCHOGUE YAPHANK RD SUITE 3
EAST PATCHOGUE NY
11772-4800
US

V. Phone/Fax

Practice location:
  • Phone: 631-618-9030
  • Fax: 631-618-9019
Mailing address:
  • Phone: 631-475-7680
  • Fax: 631-475-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number234347
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: