Healthcare Provider Details

I. General information

NPI: 1124033808
Provider Name (Legal Business Name): QUAZI AL-TARIQ II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 DOLSON AVE STE 206A
MIDDLETOWN NY
10940-6570
US

IV. Provider business mailing address

225 DOLSON AVE STE 206A
MIDDLETOWN NY
10940-6570
US

V. Phone/Fax

Practice location:
  • Phone: 845-344-2573
  • Fax: 845-341-1771
Mailing address:
  • Phone: 845-344-2573
  • Fax: 845-341-1771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number176250
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number176250
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: