Healthcare Provider Details

I. General information

NPI: 1366517930
Provider Name (Legal Business Name): TARIQ WASEEM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 33RD ST STE 306
LONG ISLAND CITY NY
11106-2329
US

IV. Provider business mailing address

3636 33RD ST STE 306
LONG ISLAND CITY NY
11106-2329
US

V. Phone/Fax

Practice location:
  • Phone: 844-403-4325
  • Fax: 424-625-0010
Mailing address:
  • Phone: 844-403-4325
  • Fax: 424-625-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number126149
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: