Provider Demographics
NPI:1235606112
Name:ISHTIAQ, MUHAMMAD ATIF
Entity Type:Individual
Prefix:
First Name:MUHAMMAD ATIF
Middle Name:
Last Name:ISHTIAQ
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 1:10755 116TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11419-2611
Mailing Address - Country:US
Mailing Address - Phone:347-635-9737
Mailing Address - Fax:
Practice Address - Street 1:10755 116TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11419-2611
Practice Address - Country:US
Practice Address - Phone:347-635-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015098183500000X
SC38084183500000X
DCPH100003440183500000X
NJ28RI04074800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist