1710961313 NPI number — NABILA NIAZ MD PA

Table of content: (NPI 1710961313)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710961313 NPI number — NABILA NIAZ MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NABILA NIAZ MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1710961313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 5TH AVENUE NORTH
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33705-1457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-821-2388
Provider Business Mailing Address Fax Number:
727-821-6887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 5TH AVENUE NORTH
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33705-1457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-821-2388
Provider Business Practice Location Address Fax Number:
727-821-6887
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NIAZ
Authorized Official First Name:
NABILA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-821-2388

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 46394 . This is a "BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DD2999 . This is a "RAILROAD RETIREMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 022630400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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