Provider Demographics
NPI:1215002910
Name:SUNDER M IQBAL MD PC
Entity Type:Organization
Organization Name:SUNDER M IQBAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNDER
Authorized Official - Middle Name:MASIH
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-458-0582
Mailing Address - Street 1:5606 BEAR ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1648
Mailing Address - Country:US
Mailing Address - Phone:315-458-0582
Mailing Address - Fax:315-458-5390
Practice Address - Street 1:5606 BEAR ROAD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1648
Practice Address - Country:US
Practice Address - Phone:315-458-0582
Practice Address - Fax:315-458-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1053671207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00448279Medicaid
B76940Medicare UPIN
51137RMedicare ID - Type Unspecified
30137BMedicare ID - Type Unspecified