Provider Demographics
NPI:1467561043
Name:RASOOL, AYAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:AYAZ
Middle Name:
Last Name:RASOOL
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 1:7603 113TH ST
Mailing Address - Street 2:STE M6
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6585
Mailing Address - Country:US
Mailing Address - Phone:718-268-7262
Mailing Address - Fax:718-263-6418
Practice Address - Street 1:7603 113TH ST
Practice Address - Street 2:SUITE M6
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6585
Practice Address - Country:US
Practice Address - Phone:718-268-7262
Practice Address - Fax:718-263-6418
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152821208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00763731Medicaid
NYB88593Medicare UPIN
NY00763731Medicaid