1669438875 NPI number — MAHMOOD MEHDI KAZMI

Table of content: MAHMOOD MEHDI KAZMI (NPI 1669438875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669438875 NPI number — MAHMOOD MEHDI KAZMI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAZMI
Provider First Name:
MAHMOOD
Provider Middle Name:
MEHDI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669438875
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4234 BRONX BLVD
Provider Second Line Business Mailing Address:
FRNT 1
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10466-2669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-515-4347
Provider Business Mailing Address Fax Number:
718-653-8641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3329 BAINBRIDGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-515-4347
Provider Business Practice Location Address Fax Number:
718-653-8641
Provider Enumeration Date:
04/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  200168 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 200168 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01611518 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1361624 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11130 . This is a "HIP CMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 196107 . This is a "MANAGED HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 134046855 . This is a "TAX ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 134046855 . This is a "1199" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5751811002 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 200168 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5282148 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0H1337 . This is a "HEALTH NET OF NORTHEAST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MK0298BB10 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P909239 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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