Healthcare Provider Details

I. General information

NPI: 1598143323
Provider Name (Legal Business Name): RIYAD MOHAMMED ROUF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COMPUTER DR W STE 100-01
ALBANY NY
12205-1613
US

IV. Provider business mailing address

5 COMPUTER DR W STE 100-01
ALBANY NY
12205-1613
US

V. Phone/Fax

Practice location:
  • Phone: 516-200-4578
  • Fax:
Mailing address:
  • Phone: 516-200-4578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number298015-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number298015
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: