Healthcare Provider Details

I. General information

NPI: 1073669289
Provider Name (Legal Business Name): MR. GHEYAS A. IQBAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 DAIL ST
NEW HYDE PARK NY
11040-2435
US

IV. Provider business mailing address

16 DAIL ST
NEW HYDE PARK NY
11040-2435
US

V. Phone/Fax

Practice location:
  • Phone: 516-746-1020
  • Fax:
Mailing address:
  • Phone: 516-746-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number036614
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: