Healthcare Provider Details

I. General information

NPI: 1720015506
Provider Name (Legal Business Name): FARZANA H. AZIZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 MEACHAM AVE
ELMONT NY
11003-3221
US

IV. Provider business mailing address

374 MEACHAM AVE
ELMONT NY
11003-3221
US

V. Phone/Fax

Practice location:
  • Phone: 516-599-2383
  • Fax: 516-599-2382
Mailing address:
  • Phone: 516-599-2383
  • Fax: 516-599-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number212238
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: