Basic Information
| Provider Information | |||||||||
| NPI: | 1093874620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AZIZ | ||||||||
| FirstName: | ANNIE | ||||||||
| MiddleName: | SAMINA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 LAKE STREET | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125505243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458639800 | ||||||||
| FaxNumber: | 8455656349 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 LAKE STREET | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125505243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458639800 | ||||||||
| FaxNumber: | 8455656349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 07/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 214696 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02087938 | 05 | NY | MEDICAID |