Provider Demographics
NPI:1487703401
Name:MASOOM H. QADEER, M.D., P.C.
Entity type:Organization
Organization Name:MASOOM H. QADEER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MASOOM
Authorized Official - Middle Name:H
Authorized Official - Last Name:QADEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-242-7246
Mailing Address - Street 1:460 HALF HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5829
Mailing Address - Country:US
Mailing Address - Phone:631-242-7246
Mailing Address - Fax:631-242-4097
Practice Address - Street 1:1993 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2719
Practice Address - Country:US
Practice Address - Phone:631-242-7246
Practice Address - Fax:631-242-4907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWS881Medicare PIN