Provider Demographics
NPI:1467476291
Name:IQBAL, AZHER
Entity Type:Individual
Prefix:
First Name:AZHER
Middle Name:
Last Name:IQBAL
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 1:6337 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1030
Mailing Address - Country:US
Mailing Address - Phone:716-852-1977
Mailing Address - Fax:716-852-1959
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-852-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19675412085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00025407303OtherUNIVERA
00025407301OtherUNIVERA
5609610OtherINDEPENDENT HEALTH
NYCRDRA1967546BOtherWORKERS COMPENSATION
NY01729473Medicaid
000525535003OtherBLUE SHIELD OF WESTERN NY
NY01729473Medicaid
G43540Medicare UPIN