Provider Demographics
NPI:1255510046
Name:RAZA MEDICAL
Entity type:Organization
Organization Name:RAZA MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:UZMA
Authorized Official - Middle Name:
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:1/29/1975
Authorized Official - Phone:516-887-0833
Mailing Address - Street 1:1221 DUTCH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1512
Mailing Address - Country:US
Mailing Address - Phone:516-887-0833
Mailing Address - Fax:
Practice Address - Street 1:1221 DUTCH BROADWAY
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1512
Practice Address - Country:US
Practice Address - Phone:516-887-0833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAZA MEDICAL.P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245735-1261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric