Provider Demographics
NPI:1326668559
Name:ARA, KAZI JANNATH (DO)
Entity type:Individual
Prefix:DR
First Name:KAZI
Middle Name:JANNATH
Last Name:ARA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8831 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5293
Mailing Address - Country:US
Mailing Address - Phone:646-680-4227
Mailing Address - Fax:
Practice Address - Street 1:8831 55TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5293
Practice Address - Country:US
Practice Address - Phone:646-680-4227
Practice Address - Fax:718-943-2625
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY325549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program