Provider Demographics
NPI:1225566524
Name:ABDELRAZEK, MOHAMED YOUSRY DORGHAM
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:YOUSRY DORGHAM
Last Name:ABDELRAZEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-4183
Mailing Address - Country:US
Mailing Address - Phone:347-808-7727
Mailing Address - Fax:347-808-7728
Practice Address - Street 1:2321 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-4183
Practice Address - Country:US
Practice Address - Phone:347-808-7727
Practice Address - Fax:347-808-7728
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302042568183500000X
NY063133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist