Healthcare Provider Details

I. General information

NPI: 1083342471
Provider Name (Legal Business Name): MUHAMMAD UMAR FAROOQ AZAM SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8855 BAY PKWY APT 3B
BROOKLYN NY
11214-6422
US

IV. Provider business mailing address

8855 BAY PKWY APT 3B
BROOKLYN NY
11214-6422
US

V. Phone/Fax

Practice location:
  • Phone: 347-330-1565
  • Fax:
Mailing address:
  • Phone: 347-330-1565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number339687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: