Provider Demographics
NPI:1366204042
Name:IFTIKHAR, MUHAMMAD AZEEM
Entity type:Individual
Prefix:
First Name:MUHAMMAD AZEEM
Middle Name:
Last Name:IFTIKHAR
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 1:502 SAINT CLAIR CIR APT D
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-4179
Mailing Address - Country:US
Mailing Address - Phone:914-335-0439
Mailing Address - Fax:
Practice Address - Street 1:700 US HIGHWAY 46 STE
Practice Address - Street 2:420
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1532
Practice Address - Country:US
Practice Address - Phone:973-882-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic