Provider Demographics
NPI:1831151695
Name:AIJAZ, ASIM (MD)
Entity type:Individual
Prefix:
First Name:ASIM
Middle Name:
Last Name:AIJAZ
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 1:400 CELEBRATION PL STE A270
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4970
Mailing Address - Country:US
Mailing Address - Phone:407-303-4078
Mailing Address - Fax:407-303-4083
Practice Address - Street 1:400 CELEBRATION PL STE A270
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4970
Practice Address - Country:US
Practice Address - Phone:407-303-4078
Practice Address - Fax:407-303-4083
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247299207RH0003X, 207RX0202X
FLME128109207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02229243Medicaid
NYH33920Medicare UPIN
NY484J01Medicare PIN