Provider Demographics
NPI:1992169338
Name:JAVED, USAMA
Entity type:Individual
Prefix:
First Name:USAMA
Middle Name:
Last Name:JAVED
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 1:223A W 231ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5301
Mailing Address - Country:US
Mailing Address - Phone:718-884-2908
Mailing Address - Fax:718-884-2904
Practice Address - Street 1:223A W 231ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5301
Practice Address - Country:US
Practice Address - Phone:718-884-2908
Practice Address - Fax:718-884-2904
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMEDICAID IN PROGRESSOtherMEDICAID IN PROGRESS