Healthcare Provider Details

I. General information

NPI: 1053611079
Provider Name (Legal Business Name): FAZLI QAZI PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST BOX 69
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST BOX 69
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-6465
  • Fax: 212-746-3856
Mailing address:
  • Phone: 212-746-6465
  • Fax: 212-746-3856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: