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General NPI Number Information
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NPI Number | 1811186083
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Entity Type | Organization
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Legal Business Name | MID-SUFFOLK MEDICAL CARE PC
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 6277 JERICHO TPKE
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City | COMMACK
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State | NY
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Zip | 11725-2837
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Country | US
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Telephone | 631-462-6644
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Fax | 631-462-9890
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Provider Business Mailing Address
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Address Line | 6277 JERICHO TPKE
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City | COMMACK
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State | NY
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Zip | 11725-2837
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Country | US
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Telephone | 631-462-6644
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Fax | 631-462-9890
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Authorized Official
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Title or Position | CEO
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Name | DR. MOHAMMED R AZAZ
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Credential | MD
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Telephone | 631-462-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 220310
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License Number State | NY
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