Provider Demographics
NPI:1679880116
Name:QURESHI, ABDUL WAHAB M
Entity Type:Individual
Prefix:
First Name:ABDUL WAHAB
Middle Name:M
Last Name:QURESHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1576 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4351
Mailing Address - Country:US
Mailing Address - Phone:212-795-1795
Mailing Address - Fax:
Practice Address - Street 1:1570-4, ST. NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1004
Practice Address - Country:US
Practice Address - Phone:212-795-1795
Practice Address - Fax:212-740-7868
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist