Provider Demographics
NPI:1952497273
Name:IQBAL, MOHAMMAD M
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:M
Last Name:IQBAL
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 1:8213 ROYAL SCARLET DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-8942
Mailing Address - Country:US
Mailing Address - Phone:315-635-7427
Mailing Address - Fax:
Practice Address - Street 1:3070 BELGIUM RD
Practice Address - Street 2:UPSTATE PSYCHIATRIC CARE
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9239
Practice Address - Country:US
Practice Address - Phone:315-402-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2393572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry