Provider Demographics
NPI:1053796862
Name:SERAJ, TARIQ
Entity type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:
Last Name:SERAJ
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 1:1 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-5458
Mailing Address - Country:US
Mailing Address - Phone:518-258-1068
Mailing Address - Fax:
Practice Address - Street 1:19 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1746
Practice Address - Country:US
Practice Address - Phone:518-943-4182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060577183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist