Healthcare Provider Details

I. General information

NPI: 1154024222
Provider Name (Legal Business Name): SHIZA IQBAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15015 75TH AVE APT 2B
FLUSHING NY
11367-2961
US

IV. Provider business mailing address

15015 75TH AVE APT 2B
FLUSHING NY
11367-2961
US

V. Phone/Fax

Practice location:
  • Phone: 347-748-8612
  • Fax:
Mailing address:
  • Phone: 347-748-8612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number118485-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: