Provider Demographics
NPI:1861411522
Name:RAZA, NADEEM (MD)
Entity type:Individual
Prefix:
First Name:NADEEM
Middle Name:
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 DUTCH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1512
Mailing Address - Country:US
Mailing Address - Phone:516-887-0833
Mailing Address - Fax:516-887-1401
Practice Address - Street 1:21 -04 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3648
Practice Address - Country:US
Practice Address - Phone:718-956-9010
Practice Address - Fax:718-956-9011
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02190123Medicaid
NY06721GMedicare ID - Type Unspecified
NY02190123Medicaid