NPIMap

Organization Active NPI

Willow Park Medical Health PC

  • Multi-Specialty Clinic/Center
  • Glen Head, NY
National Provider Identifier
1063219475
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
WILLOW PARK MEDICAL HEALTH PC
Practice address
4 Farmwoods LN
Glen Head, NY 11545-2730
Phone
(516) 507-7593
NPI assigned
Feb 25, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Azmat Iqbal, MDNPI 1669490314
Title
Physician
Phone
(516) 507-7593

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

4 Farmwoods LN
Glen Head, NY 11545-2730

Mailing address

4 Farmwoods LN
Glen Head, NY 11545-2730
Phone (516) 507-7593

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250314002070 NY Part B Supplier - Clinic/Group Practice 3577085901 Receives reassigned benefits from 13 practitioners
Practice locations: Amityville, NY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740441600000",
    "number": "1063219475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 FARMWOODS LN",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115452730",
            "telephone_number": "516-507-7593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 FARMWOODS LN",
            "city": "GLEN HEAD",
            "state": "NY",
            "postal_code": "115452730",
            "telephone_number": "516-507-7593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW PARK MEDICAL HEALTH PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-25",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A",
        "authorized_official_last_name": "IQBAL",
        "authorized_official_first_name": "AZMAT",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "516-507-7593",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Head, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.