Provider Demographics
NPI:1770886467
Name:IQBAL A SAMAD PC
Entity type:Organization
Organization Name:IQBAL A SAMAD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IQBAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-835-9866
Mailing Address - Street 1:2148 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2668
Mailing Address - Country:US
Mailing Address - Phone:716-835-9866
Mailing Address - Fax:716-835-0026
Practice Address - Street 1:2148 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2668
Practice Address - Country:US
Practice Address - Phone:716-835-9866
Practice Address - Fax:716-835-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105005261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care