Provider Demographics
NPI:1477854453
Name:SUPARIWALA, AZHAR (MD)
Entity Type:Individual
Prefix:
First Name:AZHAR
Middle Name:
Last Name:SUPARIWALA
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 1:10 AMSTERDAM AVE
Mailing Address - Street 2:APT 904
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7464
Mailing Address - Country:US
Mailing Address - Phone:646-434-9257
Mailing Address - Fax:
Practice Address - Street 1:280 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8403
Practice Address - Country:US
Practice Address - Phone:631-591-7400
Practice Address - Fax:631-591-7401
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2014-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270119207RC0000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No282N00000XHospitalsGeneral Acute Care Hospital