Provider Demographics
NPI:1659461994
Name:AZIZ, MAHJABEEN
Entity Type:Individual
Prefix:
First Name:MAHJABEEN
Middle Name:
Last Name:AZIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3192 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-9504
Mailing Address - Country:US
Mailing Address - Phone:585-593-1100
Mailing Address - Fax:585-596-4120
Practice Address - Street 1:191 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1150
Practice Address - Country:US
Practice Address - Phone:585-593-1100
Practice Address - Fax:585-596-4120
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025722302OtherUNIVERA
NYP00288992OtherRAILROAD MEDICARE
NY02341371Medicaid
NY000525215004OtherBLUE SHIELD WNY
NY2891083OtherIHA
NYIA0743Medicare ID - Type Unspecified
NY02341371Medicaid