Healthcare Provider Details

I. General information

NPI: 1376120964
Provider Name (Legal Business Name): LUBAINA HAIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22802 MERRICK BLVD FL 1
LAURELTON NY
11413-2105
US

IV. Provider business mailing address

700 HICKSVILLE RD STE 205
BETHPAGE NY
11714-3472
US

V. Phone/Fax

Practice location:
  • Phone: 646-501-4950
  • Fax: 929-455-9604
Mailing address:
  • Phone: 646-501-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number332544
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: