Provider Demographics
NPI:1750392411
Name:JIVANI, ASLAM AZIZ
Entity type:Individual
Prefix:
First Name:ASLAM
Middle Name:AZIZ
Last Name:JIVANI
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 1:34 PATTON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1731
Mailing Address - Country:US
Mailing Address - Phone:917-826-0886
Mailing Address - Fax:718-899-3300
Practice Address - Street 1:8812 QUEENS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4489
Practice Address - Country:US
Practice Address - Phone:516-589-0316
Practice Address - Fax:718-899-3300
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216241207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54-2082517Medicaid
NYH10650Medicare UPIN