Provider Demographics
NPI:1790705770
Name:ISHTIAQ, BAKHTIAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BAKHTIAR
Middle Name:
Last Name:ISHTIAQ
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 1:63 STRATTON RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7723
Mailing Address - Country:US
Mailing Address - Phone:914-574-5263
Mailing Address - Fax:
Practice Address - Street 1:WHITE PLAINS HOSPITAL CENTER
Practice Address - Street 2:DAVIS AVENUE AT EAST POST ROAD
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601
Practice Address - Country:US
Practice Address - Phone:914-681-1158
Practice Address - Fax:914-681-2878
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204974207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF73404Medicare UPIN
NY816V21Medicare ID - Type Unspecified