1679521777 NPI number — PARVEZ ASMAT MD

Table of content: PARVEZ ASMAT MD (NPI 1679521777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679521777 NPI number — PARVEZ ASMAT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASMAT
Provider First Name:
PARVEZ
Provider Middle Name:
Provider Name Prefix Text:
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:
1679521777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 GENESEE ST
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
UTICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13501-2199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-793-8806
Provider Business Mailing Address Fax Number:
315-793-8046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1656 CHAMPLIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UTICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13502-4830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-624-6116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2006

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: 2085R0202X , with the licence number:  163700 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00933160 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1637008W . This is a "WC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P010163700 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10025142 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01647929 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225087 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4102002 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426013905 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 300021948 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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