MEDICARE: DR. QUAZI AL-TARIQ II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084F0202X	Forensic Psychiatry Physician	176250	NY
2	2084P0800X	Psychiatry Physician	176250	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124033808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QUAZI AL-TARIQ II MD

Provider Business Mailing Address
First Line	:	225 DOLSON AVE STE 206A
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-6570
Country	:	US
Telephone Number	:	845-344-2573
Fax Number	:	845-341-1771

Provider Business Practice Location Address
First Line	:	225 DOLSON AVE STE 206A
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10940-6570
Country	:	US
Telephone Number	:	845-344-2573
Fax Number	:	845-341-1771

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	06/18/2024

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