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General NPI Number Information
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NPI Number | 1669626024
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Entity Type | Individual
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Provider Name | MOHAMMAD O AZAM PA
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Gender | Male
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 120 MINEOLA BLVD STE 330
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City | MINEOLA
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State | NY
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Zip | 11501-4077
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Country | US
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Telephone | 516-663-8850
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Fax |
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Provider Business Mailing Address
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Address Line | 10 E MERRICK RD SUITE 207
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City | VALLEY STREAM
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State | NY
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Zip | 11580-5800
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Country | US
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Telephone | 516-256-2017
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Fax | 516-256-2029
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 012399
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License Number State | NY
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