Provider Demographics
NPI:1497707012
Name:HAQUE, IZHAR U (MD)
Entity Type:Individual
Prefix:DR
First Name:IZHAR
Middle Name:U
Last Name:HAQUE
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 1:323 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2857
Mailing Address - Country:US
Mailing Address - Phone:631-360-0042
Mailing Address - Fax:631-360-0380
Practice Address - Street 1:323 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2857
Practice Address - Country:US
Practice Address - Phone:631-360-0042
Practice Address - Fax:631-360-0380
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161603207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
82D381Medicare ID - Type Unspecified
A64116Medicare UPIN