Provider Demographics
NPI:1902044464
Name:PERWAIZ, MUHAMMAD KHURRAM
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:KHURRAM
Last Name:PERWAIZ
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:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:646-764-5325
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK MEDICAL CTR
Practice Address - Street 2:HSC T17-040
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8172
Practice Address - Country:US
Practice Address - Phone:631-444-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265040207R00000X
NY003510207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine