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NPI Code Detail

MEDICARE: DR. OMER KHALIQUE TIPU MD

MEDICARE: DR. OMER KHALIQUE TIPU 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
1207Q00000XFamily Medicine Physician252322NY
2207QG0300XGeriatric Medicine (Family Medicine) Physician252322NY

Other Identifiers

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

General Provider Information

NPI Number : 1669601159
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OMER KHALIQUE TIPU MD
Provider Business Mailing Address
First Line : 446 MCDONALD AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11218-2212
Country : US
Telephone Number : 718-972-4200
Fax Number : 718-972-6861
Provider Business Practice Location Address
First Line : 446 MCDONALD AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11218-2212
Country : US
Telephone Number : 718-972-4200
Fax Number : 718-972-6861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2009
Last Update Date : 05/21/2024

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Directions to “ DR. OMER KHALIQUE TIPU MD” Practice Location

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