Provider Demographics
NPI:1053700021
Name:AZEEM, PAULEEN
Entity type:Individual
Prefix:
First Name:PAULEEN
Middle Name:
Last Name:AZEEM
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 1:27 TAMARA CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4147
Mailing Address - Country:US
Mailing Address - Phone:631-366-5848
Mailing Address - Fax:631-366-5883
Practice Address - Street 1:883 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2613
Practice Address - Country:US
Practice Address - Phone:631-366-5848
Practice Address - Fax:631-366-5883
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028040124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist