Provider Demographics
NPI:1033543707
Name:M Q ISLAM PHYSICIAN, PLLC
Entity Type:Organization
Organization Name:M Q ISLAM PHYSICIAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:Q
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-589-4981
Mailing Address - Street 1:20 OLD COURTHOUSE RD
Mailing Address - Street 2:NEW HYDE PARK
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1229
Mailing Address - Country:US
Mailing Address - Phone:516-589-4981
Mailing Address - Fax:718-424-1311
Practice Address - Street 1:40-27 74TH STREET
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-0000
Practice Address - Country:US
Practice Address - Phone:718-424-1300
Practice Address - Fax:718-424-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2480332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty