1538231493 NPI number — DR. MUHAMMAD SIDDIQUE TARIQ QURESHI M.D.

Table of content: DR. MUHAMMAD SIDDIQUE TARIQ QURESHI M.D. (NPI 1538231493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538231493 NPI number — DR. MUHAMMAD SIDDIQUE TARIQ QURESHI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QURESHI
Provider First Name:
MUHAMMAD
Provider Middle Name:
SIDDIQUE TARIQ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
QUERSHI
Provider Other First Name:
M.S. TARIQ
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538231493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 WILLOW POND WAY
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
PENFIELD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14526-2638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-337-5420
Provider Business Mailing Address Fax Number:
585-377-3690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 WILLOW POND WAY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
PENFIELD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14526-2638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-337-5420
Provider Business Practice Location Address Fax Number:
585-377-3690
Provider Enumeration Date:
11/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  204780 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01890624 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".