Provider Demographics
NPI:1356331763
Name:AZAZ, MOHAMMED R (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:R
Last Name:AZAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6277 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2837
Mailing Address - Country:US
Mailing Address - Phone:631-462-6644
Mailing Address - Fax:631-462-9890
Practice Address - Street 1:6277 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2837
Practice Address - Country:US
Practice Address - Phone:631-462-6644
Practice Address - Fax:631-462-9890
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY220310207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02131226Medicaid
H32116Medicare UPIN
NY105031Medicare ID - Type Unspecified