Healthcare Provider Details

I. General information

NPI: 1225101991
Provider Name (Legal Business Name): SYED HYDER REZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MAIN AVE PMCC
NORWALK CT
06851-1547
US

IV. Provider business mailing address

345 MAIN AVE PMCC
NORWALK CT
06851-1547
US

V. Phone/Fax

Practice location:
  • Phone: 203-849-7777
  • Fax: 203-846-4477
Mailing address:
  • Phone: 203-849-7777
  • Fax: 203-846-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number030279
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: