Provider Demographics
NPI:1790092492
Name:AWAD, NABIL
Entity Type:Individual
Prefix:MR
First Name:NABIL
Middle Name:
Last Name:AWAD
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 1:228 ROUTE 32
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10917-3662
Mailing Address - Country:US
Mailing Address - Phone:845-928-1117
Mailing Address - Fax:845-928-1120
Practice Address - Street 1:228 ROUTE 32
Practice Address - Street 2:
Practice Address - City:CENTRAL VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10917-3662
Practice Address - Country:US
Practice Address - Phone:845-928-1117
Practice Address - Fax:845-928-1120
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02591028Medicaid
NY02591028Medicaid