Provider Demographics
NPI:1952474595
Name:HAQUE, MUHAMMAD
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:
Last Name:HAQUE
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 1:565 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3424
Mailing Address - Country:US
Mailing Address - Phone:212-283-2099
Mailing Address - Fax:212-234-2939
Practice Address - Street 1:3418 BROADWAY OFC 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-7408
Practice Address - Country:US
Practice Address - Phone:212-283-2099
Practice Address - Fax:212-234-2939
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122027208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB80200Medicare UPIN