Basic Information
| Provider Information | |||||||||
| NPI: | 1558441584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IQBAL | ||||||||
| FirstName: | MUSARRAT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 PATCHOGUE YAPHANK RD | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | EAST PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117724800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314757680 | ||||||||
| FaxNumber: | 6314757683 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 SILLS ROAD | ||||||||
| Address2: | BUILDING 15, SUITE F | ||||||||
| City: | EAST PATCHOGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316189030 | ||||||||
| FaxNumber: | 6316189019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 05/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 234347 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02697996 | 05 | NY | MEDICAID |