Basic Information
| Provider Information | |||||||||
| NPI: | 1154588788 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AWAD | ||||||||
| FirstName: | MOHAMED | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 RXR PLZ | ||||||||
| Address2: | |||||||||
| City: | UNIONDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115561301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167834600 | ||||||||
| FaxNumber: | 5167834612 | ||||||||
| Practice Location | |||||||||
| Address1: | 7049 AUSTIN ST | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113751033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182801245 | ||||||||
| FaxNumber: | 7182801253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 01/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 43384 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 01067509A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 254226 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 76764846 | 01 | NY | PERSONAL IDENTIFICATION NUMBER | OTHER |