1972831782 NPI number — AYESHA TASADDAQ MD

Table of content: AYESHA TASADDAQ MD (NPI 1972831782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972831782 NPI number — AYESHA TASADDAQ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TASADDAQ
Provider First Name:
AYESHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIASAT
Provider Other First Name:
AYESHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972831782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601
Provider Second Line Business Mailing Address:
10869 RTE 36 SOUTH
Provider Business Mailing Address City Name:
DANSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14437-0601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-335-3416
Provider Business Mailing Address Fax Number:
585-335-8695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 RED JACKET ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
DANSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14437-0339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-335-6041
Provider Business Practice Location Address Fax Number:
585-335-6764
Provider Enumeration Date:
12/07/2009

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: 207Q00000X , with the licence number:  258140 , 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: 03252595 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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