Provider Demographics
NPI:1649204769
Name:HAQUE, FAKHRUN N (MD)
Entity Type:Individual
Prefix:
First Name:FAKHRUN
Middle Name:N
Last Name:HAQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 QUEENS BLVD
Mailing Address - Street 2:1C
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1056
Mailing Address - Country:US
Mailing Address - Phone:718-606-1123
Mailing Address - Fax:718-606-1450
Practice Address - Street 1:9229 QUEENS BLVD
Practice Address - Street 2:1C
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1056
Practice Address - Country:US
Practice Address - Phone:718-606-1123
Practice Address - Fax:718-606-1450
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194210207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
41J381Medicare ID - Type Unspecified