Provider Demographics
NPI:1033214317
Name:QURESHI, PERVAIZ IQBAL (MD)
Entity Type:Individual
Prefix:
First Name:PERVAIZ
Middle Name:IQBAL
Last Name:QURESHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596
Mailing Address - Country:US
Mailing Address - Phone:347-242-6261
Mailing Address - Fax:212-318-4045
Practice Address - Street 1:1921 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-3103
Practice Address - Country:US
Practice Address - Phone:718-604-0717
Practice Address - Fax:718-604-0718
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196325207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01525828Medicaid
NY63J911Medicare ID - Type Unspecified
NY01525828Medicaid