Provider Demographics
NPI:1346426673
Name:AZAB, AYMAN A
Entity Type:Individual
Prefix:MR
First Name:AYMAN
Middle Name:A
Last Name:AZAB
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 1:1129 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-2707
Mailing Address - Country:US
Mailing Address - Phone:518-631-0284
Mailing Address - Fax:
Practice Address - Street 1:1203 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-3501
Practice Address - Country:US
Practice Address - Phone:518-393-4549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist