| M Q Islam Physician, Pllc | |
|
40-27 74th Street Elmhurst NY 11373-0000 | |
| (718) 424-1300 | |
| (718) 424-1311 |
| Full Name | M Q Islam Physician, Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 40-27 74th Street, Elmhurst, New York |
| Authorized Official Name and Position | Mohammed Q. Islam (PRESIDENT) |
| Authorized Official Contact | 5165894981 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| M Q Islam Physician, Pllc 20 Old Courthouse Rd New Hyde Park New Hyde Park NY 11040-1229 Ph: (516) 589-4981 | M Q Islam Physician, Pllc 40-27 74th Street Elmhurst NY 11373-0000 Ph: (718) 424-1300 |
| NPI Number | 1033543707 |
|---|---|
| Provider Enumeration Date | 08/29/2013 |
| Last Update Date | 08/29/2013 |
| Medicare PECOS PAC ID | 4688809767 |
|---|---|
| Medicare Enrollment ID | O20131025000800 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033543707 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 248033 (New York) | Primary |
| Provider Name | Mohammed Q Islam |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1245205012 PECOS PAC ID: 3971515024 Enrollment ID: I20131025000730 |
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