Healthcare Provider Details

I. General information

NPI: 1689301368
Provider Name (Legal Business Name): MOHAMMAD ATHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NESCONSET HIGHWAY BUILDING 10 UNIT D
STONY BROOK NY
11790
US

IV. Provider business mailing address

10011 70TH AVE
FOREST HILLS NY
11375-5132
US

V. Phone/Fax

Practice location:
  • Phone: 631-981-2663
  • Fax: 212-203-9223
Mailing address:
  • Phone: 917-946-9681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number316870
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number316870
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number316870
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: