Healthcare Provider Details

I. General information

NPI: 1942340260
Provider Name (Legal Business Name): WAHEED SYED HAQUE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 FORT WASHINGTON AVE
NEW YORK NY
10032-3739
US

IV. Provider business mailing address

2376 REDMOND RD
NORTH BELLMORE NY
11710-2152
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-4600
  • Fax: 212-305-7439
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: