Provider Demographics
NPI:1164593851
Name:IQBAL, MIR JAVED (MD)
Entity Type:Individual
Prefix:
First Name:MIR
Middle Name:JAVED
Last Name:IQBAL
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 1:4277 HEMPSTEAD TPK
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714
Mailing Address - Country:US
Mailing Address - Phone:516-735-9210
Mailing Address - Fax:516-735-9247
Practice Address - Street 1:4277 HEMPSTEAD TPK
Practice Address - Street 2:SUITE 107
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714
Practice Address - Country:US
Practice Address - Phone:516-735-9210
Practice Address - Fax:516-735-9247
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138686207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110019339OtherRAILROAD MDCR
NY56D181Medicare ID - Type Unspecified
C11364Medicare UPIN