Provider Demographics
NPI:1154560175
Name:AZIZ, SAMIR
Entity type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:
Last Name:AZIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SAMIR
Other - Middle Name:
Other - Last Name:AZIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:172 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1634
Mailing Address - Country:US
Mailing Address - Phone:845-527-8008
Mailing Address - Fax:201-820-4365
Practice Address - Street 1:172 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1634
Practice Address - Country:US
Practice Address - Phone:201-401-4494
Practice Address - Fax:201-342-5247
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-14
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10909252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency