Organization
MID-SUFFOLK MEDICAL CARE PC
Active
Other names
Island Medical Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMED R AZAZ MD (CEO)
(631) 462-6644
Entity
Organization
Contact information
Practice address
6277 JERICHO TPKE, COMMACK, NY 11725-2837
(631) 462-6644
(631) 462-9890
Mailing address
6277 JERICHO TPKE, COMMACK, NY 11725-2837
(631) 462-6644
(631) 462-9890
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
220310
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02131226
—
NY
Enumeration date
10/23/2007
Last updated
01/08/2020
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