Provider Demographics
NPI:1639197486
Name:TAK, IQBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:IQBAL
Middle Name:
Last Name:TAK
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 1:8561 111TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1638
Mailing Address - Country:US
Mailing Address - Phone:718-850-2881
Mailing Address - Fax:
Practice Address - Street 1:8561 111TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1638
Practice Address - Country:US
Practice Address - Phone:718-850-2881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195390207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01889665Medicaid
NYG65769Medicare UPIN
NY02719Medicare ID - Type Unspecified
NY01889665Medicaid