Provider Demographics
NPI:1245631332
Name:IFTIKHAR, JAVAID HASSAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:DR
First Name:JAVAID
Middle Name:HASSAN
Last Name:IFTIKHAR
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2216 KIMBALL ST # 6M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5111
Mailing Address - Country:US
Mailing Address - Phone:718-743-0610
Mailing Address - Fax:
Practice Address - Street 1:2216 KIMBALL ST # 6M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5111
Practice Address - Country:US
Practice Address - Phone:718-743-0610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF345244363LF0000X
NY691249163W00000X
NY402442363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse