Provider Demographics
NPI:1891195863
Name:DARWISH, MAZEN
Entity Type:Individual
Prefix:
First Name:MAZEN
Middle Name:
Last Name:DARWISH
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 1:32 E 170TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-7013
Mailing Address - Country:US
Mailing Address - Phone:718-588-6825
Mailing Address - Fax:
Practice Address - Street 1:32 E 170TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-7013
Practice Address - Country:US
Practice Address - Phone:718-588-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist