Provider Demographics
NPI:1992698252
Name:MOHAMED, ABDIAZIZ NUR
Entity type:Individual
Prefix:
First Name:ABDIAZIZ
Middle Name:NUR
Last Name:MOHAMED
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 1:78 GROVE ST UNIT 388
Mailing Address - Street 2:
Mailing Address - City:NORTH CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03860-3621
Mailing Address - Country:US
Mailing Address - Phone:718-577-7719
Mailing Address - Fax:
Practice Address - Street 1:78 GROVE ST UNIT 388
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-3621
Practice Address - Country:US
Practice Address - Phone:718-577-7719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH991849171WV0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications