Provider Demographics
NPI:1033492558
Name:IQBAL, MOHAMMAD SOHAIB
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:SOHAIB
Last Name:IQBAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MARIN BLVD
Mailing Address - Street 2:APT. 3I
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3654
Mailing Address - Country:US
Mailing Address - Phone:201-303-2771
Mailing Address - Fax:
Practice Address - Street 1:9255 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5322
Practice Address - Country:US
Practice Address - Phone:201-303-2771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03322500183500000X
NY056688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist