Provider Demographics
NPI:1083603070
Name:NAWAZ, ARAIN MOHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:ARAIN
Middle Name:MOHAMMAD
Last Name:NAWAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 BELLE TERRE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2500
Mailing Address - Country:US
Mailing Address - Phone:631-928-0240
Mailing Address - Fax:631-928-0855
Practice Address - Street 1:620 BELLE TERRE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2500
Practice Address - Country:US
Practice Address - Phone:631-928-0240
Practice Address - Fax:631-928-0855
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124365207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00442388Medicaid
B13238Medicare UPIN
NY335351Medicare PIN