Provider Demographics
NPI:1043491616
Name:ASLAM, IMTIAZ (RPH)
Entity Type:Individual
Prefix:MR
First Name:IMTIAZ
Middle Name:
Last Name:ASLAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-7038
Mailing Address - Country:US
Mailing Address - Phone:845-744-8845
Mailing Address - Fax:
Practice Address - Street 1:2460 STATE ROUTE 52
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-7038
Practice Address - Country:US
Practice Address - Phone:845-744-8845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1043491616Medicaid
NY1043491616Medicare UPIN
NY1043491616Medicare NSC