MEDICARE: AYYUB IMTIAZ 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	2084P0800X	Psychiatry Physician	337593	NY

General Provider Information

NPI Number	:	1275104994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYYUB IMTIAZ MD

Provider Business Mailing Address
First Line	:	451 CLARKSON AVE RM 4076
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2054
Country	:	US
Telephone Number	:	718-245-2366
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 CLARKSON AVE RM 4076
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2054
Country	:	US
Telephone Number	:	718-245-2366
Fax Number	:

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

Provider Enumeration Date	:	07/03/2021
Last Update Date	:	12/17/2025

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