Provider Demographics
NPI:1912556077
Name:CHEEMA, IFTIKHAR
Entity Type:Individual
Prefix:
First Name:IFTIKHAR
Middle Name:
Last Name:CHEEMA
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 1:1729 ATHERTON AVE FL 2ND
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1714
Mailing Address - Country:US
Mailing Address - Phone:646-401-1115
Mailing Address - Fax:
Practice Address - Street 1:11013 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2321
Practice Address - Country:US
Practice Address - Phone:718-849-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345025-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily