Healthcare Provider Details

I. General information

NPI: 1306868567
Provider Name (Legal Business Name): MUHAMMAD IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 DOGWOOD RD
ROSLYN NY
11576-3005
US

IV. Provider business mailing address

193 DOGWOOD RD
ROSLYN NY
11576-3005
US

V. Phone/Fax

Practice location:
  • Phone: 718-416-4389
  • Fax: 718-416-3652
Mailing address:
  • Phone: 516-484-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number226777
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: