Provider Demographics
NPI:1992295117
Name:ISHFAQ, MARYA
Entity type:Individual
Prefix:
First Name:MARYA
Middle Name:
Last Name:ISHFAQ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3730
Mailing Address - Country:US
Mailing Address - Phone:516-301-7081
Mailing Address - Fax:
Practice Address - Street 1:118 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-3491
Practice Address - Country:US
Practice Address - Phone:718-552-2990
Practice Address - Fax:718-552-2991
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist