Provider Demographics
NPI:1912182791
Name:HAQ, SHARMIN
Entity Type:Individual
Prefix:DR
First Name:SHARMIN
Middle Name:
Last Name:HAQ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 UTOPIA PKWY
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2149
Mailing Address - Country:US
Mailing Address - Phone:718-762-2362
Mailing Address - Fax:
Practice Address - Street 1:11510 MERRICK BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1852
Practice Address - Country:US
Practice Address - Phone:718-297-8350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-30
Last Update Date:2007-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY051091Medicaid