Provider Demographics
NPI:1356894216
Name:ABDELAZIZ, MANAL
Entity type:Individual
Prefix:
First Name:MANAL
Middle Name:
Last Name:ABDELAZIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 3RD AVE
Mailing Address - Street 2:4D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-663-1842
Mailing Address - Fax:
Practice Address - Street 1:7105 3RD AVE
Practice Address - Street 2:PMB 238
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1308
Practice Address - Country:US
Practice Address - Phone:718-663-1842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009490172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker