Provider Demographics
NPI:1801824388
Name:IQBAL, MOHAMMAD ASIF (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ASIF
Last Name:IQBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMMAD
Other - Middle Name:ASIF
Other - Last Name:IQBAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:17 CORTLAND CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4309
Mailing Address - Country:US
Mailing Address - Phone:646-287-9405
Mailing Address - Fax:866-637-2007
Practice Address - Street 1:1219 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3411
Practice Address - Country:US
Practice Address - Phone:646-287-9405
Practice Address - Fax:866-637-2007
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230025174400000X, 2081N0008X, 2081P2900X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02526350Medicaid
NY0792J1Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY02526350Medicaid
NYI20643Medicare UPIN