MEDICARE: MR. SYED HAQUE PA

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	363AM0700X	Medical Physician Assistant	0163041	NY

General Provider Information

NPI Number	:	1144567124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SYED HAQUE PA

Provider Business Mailing Address
First Line	:	1759 POWERS AVE
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-3935
Country	:	US
Telephone Number	:	516-368-4433
Fax Number	:

Provider Business Practice Location Address
First Line	:	16806 HILLSIDE AVE
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-4341
Country	:	US
Telephone Number	:	718-739-7400
Fax Number	:

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

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	01/10/2013

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