Provider Demographics
NPI:1710918818
Name:DIN, IFTIKHAR UD (MD)
Entity Type:Individual
Prefix:
First Name:IFTIKHAR
Middle Name:UD
Last Name:DIN
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 1:326 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3311
Mailing Address - Country:US
Mailing Address - Phone:718-965-1234
Mailing Address - Fax:718-965-2674
Practice Address - Street 1:326 7TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3311
Practice Address - Country:US
Practice Address - Phone:718-965-1234
Practice Address - Fax:718-965-2674
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148763207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00705257Medicaid
NY00705257Medicaid
NYB78881Medicare UPIN