Provider Demographics
NPI:1669438875
Name:KAZMI, MAHMOOD MEHDI
Entity Type:Individual
Prefix:
First Name:MAHMOOD
Middle Name:MEHDI
Last Name:KAZMI
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 1:4234 BRONX BLVD
Mailing Address - Street 2:FRNT 1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2669
Mailing Address - Country:US
Mailing Address - Phone:718-515-4347
Mailing Address - Fax:718-653-8641
Practice Address - Street 1:3329 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2801
Practice Address - Country:US
Practice Address - Phone:718-515-4347
Practice Address - Fax:718-653-8641
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200168174400000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01611518Medicaid
NY1361624OtherUNITED HEALTH CARE
NY11130OtherHIP CMO
NY196107OtherMANAGED HEALTHNET
NY134046855OtherTAX ID#
NY134046855Other1199
NY5751811002OtherCIGNA
NY200168OtherHIP
NY5282148OtherAETNA
NY0H1337OtherHEALTH NET OF NORTHEAST
NYMK0298BB10OtherBC/BS
NYP909239OtherOXFORD
NY11130OtherHIP CMO
NY134046855OtherTAX ID#