Basic Information
| Provider Information | |||||||||
| NPI: | 1003979121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AZAD | ||||||||
| FirstName: | ABUL | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 2125 RIVER ROAD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188318530 | ||||||||
| FaxNumber: | 5188318545 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 204594 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 204594 | NY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RP1001X | 204594 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207P00000X | 204594 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01759833 | 05 | NY | MEDICAID | 10020530 | 01 | NY | CDPHP | OTHER | 135032 | 01 | NY | GHI/HMO | OTHER | 200852 | 01 | NY | SENIOR WHOLE HEALTH | OTHER | 6022794 | 01 | NY | MVP HEALTHCARE | OTHER | 7542070 | 01 | NY | AETNA | OTHER | 28R331 | 01 | NY | EMPIRE BC | OTHER | 000471066006 | 01 | NY | BSNENY | OTHER | 090226000061 | 01 | NY | FIDELIS | OTHER |