1851564942 NPI number — MOHAMMED SEEDAT MD AND CORAL NICHOLAS MD PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851564942 NPI number — MOHAMMED SEEDAT MD AND CORAL NICHOLAS MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAMMED SEEDAT MD AND CORAL NICHOLAS MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1851564942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1316 BLACK RIVER BLVD N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROME
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13440-3601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-336-3353
Provider Business Mailing Address Fax Number:
315-336-3356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1316 BLACK RIVER BLVD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13440-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-336-3353
Provider Business Practice Location Address Fax Number:
315-336-3356
Provider Enumeration Date:
04/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SEEDAT
Authorized Official First Name:
MOHAMMED
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
315-336-3353

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  202800 , 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: 02731588 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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