Provider Demographics
NPI:1700811973
Name:NAQVI, SYEDQAMBAR RAZA (MD)
Entity Type:Individual
Prefix:
First Name:SYEDQAMBAR
Middle Name:RAZA
Last Name:NAQVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BLYDENBURG AVENUE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-0000
Mailing Address - Country:US
Mailing Address - Phone:631-742-5214
Mailing Address - Fax:
Practice Address - Street 1:81 LOUDEN AVENUE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-0000
Practice Address - Country:US
Practice Address - Phone:631-789-7064
Practice Address - Fax:631-789-7886
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202988-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02049003Medicaid
45M691Medicare PIN