Provider Demographics
NPI:1932243128
Name:KIDWAI, TARIQ NAZEER
Entity Type:Individual
Prefix:MR
First Name:TARIQ
Middle Name:NAZEER
Last Name:KIDWAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2305
Mailing Address - Country:US
Mailing Address - Phone:516-742-6126
Mailing Address - Fax:
Practice Address - Street 1:712 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-3614
Practice Address - Country:US
Practice Address - Phone:718-467-1000
Practice Address - Fax:718-467-4675
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist