Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 176899 | NY |
NPI | 1003829490 |
---|---|
Provider Name | Abul Kalam Azad |
First Address | Woodmere, NY 11598-1810 |
Second Address | Far Rockaway, NY 11691-3618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01180661 | (05) | NY |
E44967 | (02) |