Provider Demographics
NPI:1770528127
Name:KAZMI, SURAYYA (MD)
Entity type:Individual
Prefix:
First Name:SURAYYA
Middle Name:
Last Name:KAZMI
Suffix:
Gender:F
Credentials:MD
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 8500 4056
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-4056
Mailing Address - Country:US
Mailing Address - Phone:302-709-4497
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:1505 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360
Practice Address - Country:US
Practice Address - Phone:302-709-4497
Practice Address - Fax:302-733-0854
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ575258U0UMedicare PIN
NJE54398Medicare UPIN