Provider Demographics
NPI:1154789873
Name:AZAD, ABUL (PA-C)
Entity type:Individual
Prefix:
First Name:ABUL
Middle Name:
Last Name:AZAD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 NEWKIRK AVE
Mailing Address - Street 2:1FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1405
Mailing Address - Country:US
Mailing Address - Phone:718-688-9055
Mailing Address - Fax:
Practice Address - Street 1:29 NEWKIRK PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6525
Practice Address - Country:US
Practice Address - Phone:718-434-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019469363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical