Provider Demographics
NPI:1093785297
Name:QURESHI, FAHIM U (MD)
Entity Type:Individual
Prefix:DR
First Name:FAHIM
Middle Name:U
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 1:26 JUNEAU BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2611
Mailing Address - Country:US
Mailing Address - Phone:917-589-7430
Mailing Address - Fax:516-692-4779
Practice Address - Street 1:333 ST VINCENT SERVICES
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:28305-5141
Practice Address - Country:US
Practice Address - Phone:718-522-6011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2158092084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY48154Medicare UPIN