Healthcare Provider Details

I. General information

NPI: 1265027502
Provider Name (Legal Business Name): DR. BELAL AZAB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W. 168TH STREET DEPARTMENT OF PATHOLOGY AND CELL BIOLOGY
NEW YORK NY
10032
US

IV. Provider business mailing address

3327 PARKWOOD AVE
RICHMOND VA
23221-3422
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5697
  • Fax:
Mailing address:
  • Phone: 804-263-2950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: