Provider Demographics
NPI:1275833824
Name:RIAZ, MARYIUM (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:MARYIUM
Middle Name:
Last Name:RIAZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MARYIUM
Other - Middle Name:
Other - Last Name:MUHAMMAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5733 157TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5518
Mailing Address - Country:US
Mailing Address - Phone:347-898-6674
Mailing Address - Fax:
Practice Address - Street 1:5733 157 ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:347-898-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002560363AM0700X
NY014032363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical