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General NPI Number Information
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NPI Number | 1154770923
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Entity Type | Individual
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Provider Name | NADIR IJAZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2016
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 35 PARK ST
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City | NEW HAVEN
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State | CT
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Zip | 06519-1110
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Country | US
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Telephone | 203-584-6907
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Fax |
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Provider Business Mailing Address
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Address Line | 333 CEDAR STREET, SHM IE-66
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City | NEW HAVEN
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State | CT
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Zip | 06510
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Country | US
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Telephone |
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MT210509
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 71457
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License Number State | CT
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