Healthcare Provider Details

I. General information

NPI: 1689226581
Provider Name (Legal Business Name): MUHAMMAD ATIF MASOOD NOORI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HARRISON ST STE 250
JOHNSON CITY NY
13790-2176
US

IV. Provider business mailing address

800 PEARL ST APT A4
ELIZABETH NJ
07202-3469
US

V. Phone/Fax

Practice location:
  • Phone: 607-763-6580
  • Fax:
Mailing address:
  • Phone: 516-603-7952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number341133
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: