Healthcare Provider Details

I. General information

NPI: 1679004154
Provider Name (Legal Business Name): ZAIN IQBAL MEMON D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2017
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7064 YELLOWSTONE BLVD STE D1
FOREST HILLS NY
11375-3564
US

IV. Provider business mailing address

7064 YELLOWSTONE BLVD STE D1
FOREST HILLS NY
11375-3564
US

V. Phone/Fax

Practice location:
  • Phone: 347-783-1818
  • Fax: 833-970-0974
Mailing address:
  • Phone: 347-783-1818
  • Fax: 833-970-0974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number303396
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: