Healthcare Provider Details

I. General information

NPI: 1780794354
Provider Name (Legal Business Name): MOHAMMED ANWARUDDIN IQBAL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX 608
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

243 BRITTANY LN
PITTSFORD NY
14534-4324
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-1077
  • Fax: 585-273-3360
Mailing address:
  • Phone: 585-275-1077
  • Fax: 585-273-3360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberIQBAM1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberIQBAM1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: