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General NPI Number Information
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NPI Number | 1396499141
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Entity Type | Individual
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Provider Name | FAWAD HASSAN VIQAR PHD
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Gender | Male
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Dates
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Enumeration Date | 02/10/2022
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 4 SMITH HAVEN MALL STE 107
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City | LAKE GROVE
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State | NY
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Zip | 11755-1219
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Country | US
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Telephone | 631-444-8053
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Fax | 631-444-4267
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Provider Business Mailing Address
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Address Line | 120 HARRISON DR
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City | CENTERPORT
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State | NY
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Zip | 11721-1306
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Country | US
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Telephone | 718-309-5815
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 024506
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 024506
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License Number State | NY
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