Provider Demographics
NPI:1083658918
Name:IQBAL, PERVAIZ (MD)
Entity type:Individual
Prefix:
First Name:PERVAIZ
Middle Name:
Last Name:IQBAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HARBOR CT E
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2435
Mailing Address - Country:US
Mailing Address - Phone:718-641-1117
Mailing Address - Fax:718-756-1391
Practice Address - Street 1:11616 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1941
Practice Address - Country:US
Practice Address - Phone:718-641-1117
Practice Address - Fax:718-756-1390
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY230198207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02512274Medicaid
NY02512274Medicaid
NYI02254Medicare UPIN