Provider Demographics
NPI:1457410607
Name:MASOOM REHAB MEDICAL OFFICE PC
Entity Type:Organization
Organization Name:MASOOM REHAB MEDICAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:ASIF
Authorized Official - Last Name:IQBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-287-9406
Mailing Address - Street 1:5420 15TH AVE
Mailing Address - Street 2:6H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4352
Mailing Address - Country:US
Mailing Address - Phone:646-287-9406
Mailing Address - Fax:718-504-7966
Practice Address - Street 1:79 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2207
Practice Address - Country:US
Practice Address - Phone:646-287-9406
Practice Address - Fax:718-504-7966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02526350Medicaid
NY07228OtherGHI MEDICARE
NYI20643Medicare UPIN
NY0792J1Medicare ID - Type Unspecified