Healthcare Provider Details

I. General information

NPI: 1780523878
Provider Name (Legal Business Name): IMAN KAMRAN QURESHI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 N OCEAN AVE
PATCHOGUE NY
11772-2004
US

IV. Provider business mailing address

116 ASH ST
VALLEY STREAM NY
11580-4802
US

V. Phone/Fax

Practice location:
  • Phone: 631-730-1189
  • Fax:
Mailing address:
  • Phone: 516-859-1599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number035509-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: