1255491239 NPI number — DR. SOHAIL A QURESHI MD

Table of content: DR. SOHAIL A QURESHI MD (NPI 1255491239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255491239 NPI number — DR. SOHAIL A QURESHI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QURESHI
Provider First Name:
SOHAIL
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1255491239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14437-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-335-3150
Provider Business Mailing Address Fax Number:
585-335-3156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14437-1717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-335-3150
Provider Business Practice Location Address Fax Number:
585-335-3156
Provider Enumeration Date:
12/11/2006

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: 207R00000X , with the licence number:  119532 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QA0505X , with the licence number: 119532 , 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: 161550341 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100680BJ . This is a "PREFERRED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P020119532 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 161550341 . This is a "TRI CORE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010119532 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010119532 . This is a "MONRO PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9708034 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00469681 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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