Provider Demographics
NPI:1326494485
Name:KAZMI, SYED SHAHAB (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:SHAHAB
Last Name:KAZMI
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 1:100 WITMER RD STE 220
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2279
Mailing Address - Country:US
Mailing Address - Phone:215-442-5132
Mailing Address - Fax:
Practice Address - Street 1:355 BARD AVE DEPT OF MEDICINE VILLA BUILDING
Practice Address - Street 2:1ST FLOOR
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1664
Practice Address - Country:US
Practice Address - Phone:718-818-2419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300693207R00000X, 208M00000X
NJ25MA10694500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist