Healthcare Provider Details

I. General information

NPI: 1083819528
Provider Name (Legal Business Name): AMER ZEIDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

1425 PORTLAND AVE BOX 287
ROCHESTER NY
14621-3001
US

V. Phone/Fax

Practice location:
  • Phone: 203-737-7103
  • Fax:
Mailing address:
  • Phone: 585-922-5067
  • Fax: 585-922-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number053058
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number053058
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number002864-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number053058
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: