Provider Demographics
NPI:1346383262
Name:NIAZI, MASOOMA (MD)
Entity Type:Individual
Prefix:
First Name:MASOOMA
Middle Name:
Last Name:NIAZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CENTER AVENUE
Mailing Address - Street 2:APT 8C
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024
Mailing Address - Country:US
Mailing Address - Phone:201-461-4958
Mailing Address - Fax:
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:BRONX LEBANON HOSPITAL CENTER
Practice Address - City:BRONX
Practice Address - State:NJ
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-518-5204
Practice Address - Fax:718-716-8252
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190148207ZC0500X, 207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12242Medicare UPIN