Provider Demographics
NPI:1679004154
Name:MEMON, ZAIN IQBAL (DO)
Entity type:Individual
Prefix:
First Name:ZAIN
Middle Name:IQBAL
Last Name:MEMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7064 YELLOWSTONE BLVD STE D1
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3564
Mailing Address - Country:US
Mailing Address - Phone:347-783-1818
Mailing Address - Fax:833-970-0974
Practice Address - Street 1:7064 YELLOWSTONE BLVD STE D1
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3564
Practice Address - Country:US
Practice Address - Phone:347-783-1818
Practice Address - Fax:833-970-0974
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-25
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303396207R00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program