Provider Demographics
NPI:1952469306
Name:ABDUL-HAQQ, ABDULLAH (LPN)
Entity Type:Individual
Prefix:
First Name:ABDULLAH
Middle Name:
Last Name:ABDUL-HAQQ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 BENNETT VILLAGE TER
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2204
Mailing Address - Country:US
Mailing Address - Phone:716-870-0159
Mailing Address - Fax:
Practice Address - Street 1:94 BENNETT VILLAGE TER
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2204
Practice Address - Country:US
Practice Address - Phone:716-870-0159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271915164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02736616Medicaid