Provider Demographics
NPI:1033210646
Name:WIQAS, AZRA (MD)
Entity Type:Individual
Prefix:DR
First Name:AZRA
Middle Name:
Last Name:WIQAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25915 E WILLISTON AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1039
Mailing Address - Country:US
Mailing Address - Phone:718-776-0555
Mailing Address - Fax:718-776-7271
Practice Address - Street 1:8602 MUSKET ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2718
Practice Address - Country:US
Practice Address - Phone:718-776-0555
Practice Address - Fax:718-776-7271
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02056100Medicaid
NY02056100Medicaid
NY07632GMedicare ID - Type Unspecified