Provider Demographics
NPI:1386667947
Name:IQBAL, SHAHZAD (MD)
Entity Type:Individual
Prefix:
First Name:SHAHZAD
Middle Name:
Last Name:IQBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 MONTAUK HWY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795
Mailing Address - Country:US
Mailing Address - Phone:631-376-0001
Mailing Address - Fax:631-676-0003
Practice Address - Street 1:222 STATION PLAZA NORTH
Practice Address - Street 2:SUITE 428
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3819
Practice Address - Country:US
Practice Address - Phone:516-663-2066
Practice Address - Fax:516-663-4655
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002011207R00000X
SC84143207RG0100X
NY254895207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132SC1Medicare ID - Type Unspecified
NYI34849Medicare UPIN