Healthcare Provider Details

I. General information

NPI: 1770641334
Provider Name (Legal Business Name): NAGHMANA M HAQUE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410-3418 BROADWAY 2ND FLOOR
NEW YORK NY
10031
US

IV. Provider business mailing address

113-04 JEWEL AVE
FOREST HILLS NY
11375
US

V. Phone/Fax

Practice location:
  • Phone: 212-283-2099
  • Fax: 212-234-2939
Mailing address:
  • Phone: 212-283-2099
  • Fax: 212-234-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number155107
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: