Provider Demographics
NPI:1558432260
Name:QADRI, SYED S (MD, DO,)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:S
Last Name:QADRI
Suffix:
Gender:M
Credentials:MD, DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191-11 FOOTHILL AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423
Mailing Address - Country:US
Mailing Address - Phone:718-316-2786
Mailing Address - Fax:718-343-7792
Practice Address - Street 1:26701 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1743
Practice Address - Country:US
Practice Address - Phone:718-343-7790
Practice Address - Fax:718-343-7792
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02045632Medicaid
NY05225AMedicare ID - Type Unspecified
NY02045632Medicaid