Provider Demographics
NPI:1295286094
Name:HAQ, RIZWAN UL (SA-C)
Entity type:Individual
Prefix:
First Name:RIZWAN
Middle Name:UL
Last Name:HAQ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2726
Mailing Address - Country:US
Mailing Address - Phone:516-643-8475
Mailing Address - Fax:
Practice Address - Street 1:512 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2726
Practice Address - Country:US
Practice Address - Phone:516-643-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14-533246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant