Provider Demographics
NPI:1093874620
Name:AZIZ, ANNIE SAMINA (MD)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:SAMINA
Last Name:AZIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5243
Mailing Address - Country:US
Mailing Address - Phone:845-863-9800
Mailing Address - Fax:845-565-6349
Practice Address - Street 1:200 LAKE STREET
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5243
Practice Address - Country:US
Practice Address - Phone:845-863-9800
Practice Address - Fax:845-565-6349
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02087938Medicaid
19V661Medicare ID - Type Unspecified
19V661Medicare PIN
NY02087938Medicaid