MEDICARE: ABUL AZAD PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	019469	NY

General Provider Information

NPI Number	:	1154789873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABUL AZAD PA-C

Provider Business Mailing Address
First Line	:	902 NEWKIRK AVE
Second Line	:	1FL
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1405
Country	:	US
Telephone Number	:	718-688-9055
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 NEWKIRK PLZ
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-6525
Country	:	US
Telephone Number	:	718-434-7545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2016
Last Update Date	:	02/09/2016

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