MEDICARE: HAQUE MEDICAL OFFICE, PC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1326358193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAQUE MEDICAL OFFICE, PC

Provider Business Mailing Address
First Line	:	540 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3823
Country	:	US
Telephone Number	:	718-633-5800
Fax Number	:	717-686-1114

Provider Business Practice Location Address
First Line	:	540 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3823
Country	:	US
Telephone Number	:	718-633-5800
Fax Number	:	717-686-1114

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SAYERA HAQUE
Credential	:	M.D.
Telephone Number	:	718-633-5800

Provider Enumeration Date	:	10/14/2010
Last Update Date	:	10/14/2010

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