Healthcare Provider Details

I. General information

NPI: 1669438875
Provider Name (Legal Business Name): MAHMOOD MEHDI KAZMI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 01/01/2024
Certification Date: 01/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3329 BAINBRIDGE AVE
BRONX NY
10467-2801
US

IV. Provider business mailing address

4234 BRONX BLVD FRNT 1
BRONX NY
10466-2669
US

V. Phone/Fax

Practice location:
  • Phone: 718-515-4347
  • Fax: 718-653-8641
Mailing address:
  • Phone: 718-515-4347
  • Fax: 718-653-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number200168
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200168
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: