Healthcare Provider Details

I. General information

NPI: 1396143806
Provider Name (Legal Business Name): MOHAMMED MAZHARUDDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 E 121ST ST FL 5
NEW YORK NY
10035
US

IV. Provider business mailing address

241 W 120TH ST
NEW YORK NY
10027-6437
US

V. Phone/Fax

Practice location:
  • Phone: 212-803-5892
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA11665200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number290568
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: