Provider Demographics
NPI:1477850790
Name:AZIZ A SOOMRO PHYSICIAN PC
Entity type:Organization
Organization Name:AZIZ A SOOMRO PHYSICIAN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZIZ
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:SOOMRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-238-1695
Mailing Address - Street 1:1 S GREELEY AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514-3346
Mailing Address - Country:US
Mailing Address - Phone:914-238-1699
Mailing Address - Fax:914-238-1695
Practice Address - Street 1:1 S GREELEY AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514-3346
Practice Address - Country:US
Practice Address - Phone:914-238-1699
Practice Address - Fax:914-238-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2466172084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02951646Medicaid
NY5454306261Medicare PIN