Provider Demographics
NPI:1750553004
Name:NABIL A AZIZ MD PC
Entity type:Organization
Organization Name:NABIL A AZIZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-452-2240
Mailing Address - Street 1:5100 W TAFT RD STE 3R
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5100 W TAFT RD STE 3R
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3809
Practice Address - Country:US
Practice Address - Phone:315-452-2240
Practice Address - Fax:315-452-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1631362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01070415Medicaid
B51298Medicare UPIN
NY01070415Medicaid