Provider Demographics
NPI:1780996983
Name:IQBAL, ADEEL AZMAT (DO)
Entity type:Individual
Prefix:
First Name:ADEEL
Middle Name:AZMAT
Last Name:IQBAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 NORTH OCEAN AVE.
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772
Mailing Address - Country:US
Mailing Address - Phone:631-913-8239
Mailing Address - Fax:631-207-8303
Practice Address - Street 1:152 NORTH OCEAN AVE.
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772
Practice Address - Country:US
Practice Address - Phone:631-913-8239
Practice Address - Fax:631-207-8303
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA3377144Medicaid
NYA300055448Medicare PIN