Healthcare Provider Details

I. General information

NPI: 1376652206
Provider Name (Legal Business Name): ADNAN IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/16/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 HARRIS BUSHVILLE RD
HARRIS NY
12742
US

IV. Provider business mailing address

300 STATE ST UNIT 96041
SOUTHLAKE TX
76092-1277
US

V. Phone/Fax

Practice location:
  • Phone: 845-333-8909
  • Fax:
Mailing address:
  • Phone: 917-336-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36379
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberS5933
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number332129
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-36379
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: