Provider Demographics
NPI:1528444601
Name:WAZIR, MOHSIN
Entity type:Individual
Prefix:
First Name:MOHSIN
Middle Name:
Last Name:WAZIR
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 1:355 E 73RD ST
Mailing Address - Street 2:APT 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3766
Mailing Address - Country:US
Mailing Address - Phone:773-941-0217
Mailing Address - Fax:
Practice Address - Street 1:355 E 73RD ST
Practice Address - Street 2:APT 3A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3766
Practice Address - Country:US
Practice Address - Phone:773-941-0217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056659204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery