Individual
MOHAMMAD O AZAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
120 MINEOLA BLVD STE 330, MINEOLA, NY 11501-4077
(516) 663-8850
Mailing address
10 E MERRICK RD, SUITE 207, VALLEY STREAM, NY 11580-5800
(516) 256-2017
(516) 256-2029
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
012399
NY
Other
Enumeration date
11/12/2008
Last updated
08/09/2022
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