Provider Demographics
NPI:1881909661
Name:ANSARI, MOHAMMAD NASEEM
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:NASEEM
Last Name:ANSARI
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 1:70 MELLOW LN
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6333
Mailing Address - Country:US
Mailing Address - Phone:516-333-2189
Mailing Address - Fax:
Practice Address - Street 1:70 MELLOW LN
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6333
Practice Address - Country:US
Practice Address - Phone:516-333-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028875183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist