Provider Demographics
NPI:1558441584
Name:IQBAL, MUSARRAT (MD)
Entity Type:Individual
Prefix:
First Name:MUSARRAT
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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Mailing Address - Street 1:250 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4800
Mailing Address - Country:US
Mailing Address - Phone:631-475-7680
Mailing Address - Fax:631-475-7683
Practice Address - Street 1:285 SILLS ROAD
Practice Address - Street 2:BUILDING 15, SUITE F
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-618-9030
Practice Address - Fax:631-618-9019
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2018-05-14
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Provider Licenses
StateLicense IDTaxonomies
NY234347207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02697996Medicaid
NY02697996Medicaid
NY0469T1Medicare UPIN