Provider Demographics
NPI:1639341597
Name:QURESHI, ANJUM AFSHAN
Entity Type:Individual
Prefix:MRS
First Name:ANJUM
Middle Name:AFSHAN
Last Name:QURESHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3515
Mailing Address - Country:US
Mailing Address - Phone:718-739-2200
Mailing Address - Fax:718-526-2830
Practice Address - Street 1:8742 169TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3632
Practice Address - Country:US
Practice Address - Phone:718-739-2200
Practice Address - Fax:718-526-2830
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03028535Medicaid
NY03028535Medicaid