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General NPI Number Information
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NPI Number | 1457410607
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Entity Type | Organization
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Legal Business Name | MASOOM REHAB MEDICAL OFFICE PC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 79 CHURCH AVE
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City | BROOKLYN
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State | NY
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Zip | 11218-2207
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Country | US
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Telephone | 646-287-9406
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Fax | 718-504-7966
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Provider Business Mailing Address
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Address Line | 5420 15TH AVE 6H
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City | BROOKLYN
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State | NY
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Zip | 11219-4352
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Country | US
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Telephone | 646-287-9406
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Fax | 718-504-7966
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOHAMMAD ASIF IQBAL
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Credential | M.D.
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Telephone | 646-287-9406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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