1285639518 NPI number — DR. MAZIN A DHAFIR M.D.

Table of content: DR. MAZIN A DHAFIR M.D. (NPI 1285639518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285639518 NPI number — DR. MAZIN A DHAFIR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DHAFIR
Provider First Name:
MAZIN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285639518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4085 SENECA ST
Provider Second Line Business Mailing Address:
STE 3
Provider Business Mailing Address City Name:
WEST SENECA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14224-3000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-674-1180
Provider Business Mailing Address Fax Number:
716-674-2037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4085 SENECA ST
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
WEST SENECA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14224-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-674-1180
Provider Business Practice Location Address Fax Number:
716-674-2037
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  154861-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207NS0135X , with the licence number: 154861-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NP0225X , with the licence number: 154861-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 070001676 . This is a "MEDICARE TRAVELERS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161271451 . This is a "COMMERCIAL CLAIMS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00010045001 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161271451 . This is a "EMPIRE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000502109001 . This is a "BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4464532 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0301846 . This is a "INDEPENDENT HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P11129370 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 161271451 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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