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General NPI Number Information
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NPI Number | 1053700021
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Entity Type | Individual
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Provider Name | PAULEEN AZEEM
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Gender | Female
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 883 E MAIN ST
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City | RIVERHEAD
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State | NY
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Zip | 11901-2613
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Country | US
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Telephone | 631-366-5848
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Fax | 631-366-5883
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Provider Business Mailing Address
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Address Line | 27 TAMARA CT
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City | MELVILLE
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State | NY
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Zip | 11747-4147
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Country | US
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Telephone | 631-366-5848
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Fax | 631-366-5883
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 028040
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License Number State | NY
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