Healthcare Provider Details

I. General information

NPI: 1235193087
Provider Name (Legal Business Name): SYED IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 E STATE ST STE 106
GLOVERSVILLE NY
12078-1203
US

IV. Provider business mailing address

99 E STATE ST STE 106
GLOVERSVILLE NY
12078-1203
US

V. Phone/Fax

Practice location:
  • Phone: 518-773-5393
  • Fax:
Mailing address:
  • Phone: 518-773-5393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number220469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: