Healthcare Provider Details

I. General information

NPI: 1053100230
Provider Name (Legal Business Name): QAMAR ISHFAQ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/25/2025
Certification Date: 05/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8460 123RD ST FL 2
KEW GARDENS NY
11415-3305
US

IV. Provider business mailing address

8460 123RD ST FL 2
KEW GARDENS NY
11415-3305
US

V. Phone/Fax

Practice location:
  • Phone: 929-478-1655
  • Fax:
Mailing address:
  • Phone: 929-478-1655
  • Fax: 929-478-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number053326
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: