Provider Demographics
NPI:1215377106
Name:MOHAMED, SAJID (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:SAJID
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22218 93RD RD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1936
Mailing Address - Country:US
Mailing Address - Phone:917-683-4182
Mailing Address - Fax:
Practice Address - Street 1:22218 93RD RD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1936
Practice Address - Country:US
Practice Address - Phone:917-683-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016596363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant