Provider Demographics
NPI:1174638811
Name:AZAMY, TAUFIQ M (MD)
Entity Type:Individual
Prefix:
First Name:TAUFIQ
Middle Name:M
Last Name:AZAMY
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 1:8727 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7847
Mailing Address - Country:US
Mailing Address - Phone:718-850-1500
Mailing Address - Fax:718-850-4444
Practice Address - Street 1:88-66 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-850-1500
Practice Address - Fax:718-850-4444
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2088352084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01896840Medicaid
NY01896840Medicaid
04157Medicare UPIN