Provider Demographics
NPI:1699389163
Name:AZAD, ABUL KALAM (MD, MSC, PHD)
Entity Type:Individual
Prefix:DR
First Name:ABUL KALAM
Middle Name:
Last Name:AZAD
Suffix:
Gender:M
Credentials:MD, MSC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 METROPOLITAN AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6263
Mailing Address - Country:US
Mailing Address - Phone:713-815-1105
Mailing Address - Fax:
Practice Address - Street 1:1635 POPLAR ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2600
Practice Address - Country:US
Practice Address - Phone:718-405-8109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAZADA1207SC0300X, 207SG0203X, 207SM0001X, 247ZC0005X, 207SG0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0205XAllopathic & Osteopathic PhysiciansMedical GeneticsPh.D. Medical GeneticsGroup - Multi-Specialty
No207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical CytogeneticsGroup - Multi-Specialty
No207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular GeneticsGroup - Multi-Specialty
No207SM0001XAllopathic & Osteopathic PhysiciansMedical GeneticsMolecular Genetic PathologyGroup - Multi-Specialty
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA