Provider Demographics
NPI:1720644909
Name:TARIQ, NISHAY (MD)
Entity Type:Individual
Prefix:MS
First Name:NISHAY
Middle Name:
Last Name:TARIQ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SOCKANOSSET CROSS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5558
Mailing Address - Country:US
Mailing Address - Phone:401-946-6200
Mailing Address - Fax:401-275-1992
Practice Address - Street 1:75 SOCKANOSSET CROSS RD STE 100
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5558
Practice Address - Country:US
Practice Address - Phone:401-946-6200
Practice Address - Fax:401-275-1992
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2024-04-02
Deactivation Date:2020-01-13
Deactivation Code:
Reactivation Date:2020-02-27
Provider Licenses
StateLicense IDTaxonomies
RIMD19165207QG0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program