=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003979121
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABUL K AZAD MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 05/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2125 RIVER ROAD SUITE 203
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-831-8530
-----------------------------------------------------
Fax | 518-831-8545
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 TROY SCHENECTADY RD STE 203
-----------------------------------------------------
City | LATHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12110-2461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-782-3700
-----------------------------------------------------
Fax | 518-782-3799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 204594
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 204594
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 204594
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 204594
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------