Provider Demographics
NPI:1073669289
Name:IQBAL, GHEYAS A
Entity Type:Individual
Prefix:MR
First Name:GHEYAS
Middle Name:A
Last Name:IQBAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 DAIL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2435
Mailing Address - Country:US
Mailing Address - Phone:516-746-1020
Mailing Address - Fax:
Practice Address - Street 1:16 DAIL ST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2435
Practice Address - Country:US
Practice Address - Phone:516-746-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036614183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist