Provider Demographics
NPI:1780772368
Name:AWAN, ABDUL J (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:J
Last Name:AWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7914 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2704
Mailing Address - Country:US
Mailing Address - Phone:718-836-2800
Mailing Address - Fax:718-836-8010
Practice Address - Street 1:7914 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2704
Practice Address - Country:US
Practice Address - Phone:718-836-2800
Practice Address - Fax:718-836-8010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114958-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine