Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 276227 | NY |
NPI | 1144636754 |
---|---|
Provider Name | Shumail Haque |
First Address | Levittown, NY 11756-3718 |
Second Address | Levittown, NY 11756-3718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2014 |
Last Update Date | 24/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04307773 | (05) | NY |