Healthcare Provider Details

I. General information

NPI: 1477850790
Provider Name (Legal Business Name): AZIZ A SOOMRO PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S GREELEY AVE SUITE 302
CHAPPAQUA NY
10514-3346
US

IV. Provider business mailing address

1 S GREELEY AVE SUITE 302
CHAPPAQUA NY
10514-3346
US

V. Phone/Fax

Practice location:
  • Phone: 914-238-1699
  • Fax: 914-238-1695
Mailing address:
  • Phone: 914-238-1699
  • Fax: 914-238-1695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number246617
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number246617
License Number StateNY

VIII. Authorized Official

Name: DR. AZIZ AHMED SOOMRO
Title or Position: PRESIDENT
Credential: MD
Phone: 914-238-1695