MEDICARE: MUHAMMAD M. HAQUE, MD, 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	:	1376789461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUHAMMAD M. HAQUE, MD, PC

Provider Business Mailing Address
First Line	:	21 GRAND AVE
Second Line	:	SUITE 509
City	:	PALISADES PARK
State	:	NJ
Zip	:	07650-1076
Country	:	US
Telephone Number	:	917-597-8810
Fax Number	:

Provider Business Practice Location Address
First Line	:	3410 BROADWAY # 3418
Second Line	:	2ND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10031-7400
Country	:	US
Telephone Number	:	917-597-8810
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MUHAMMAD M HAQUE
Credential	:	M.D.
Telephone Number	:	917-597-8810

Provider Enumeration Date	:	12/19/2008
Last Update Date	:	12/19/2008

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