Provider Demographics
NPI:1326710377
Name:AZAAN MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:AZAAN MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-737-7151
Mailing Address - Street 1:2417 W PRATT BLVD APT 1L
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4635
Mailing Address - Country:US
Mailing Address - Phone:201-737-7151
Mailing Address - Fax:
Practice Address - Street 1:2417 W PRATT BLVD APT 1L
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-4635
Practice Address - Country:US
Practice Address - Phone:201-737-7151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory