Healthcare Provider Details

I. General information

NPI: 1841505963
Provider Name (Legal Business Name): MIRZA A BAIG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 SHERIDAN DR 6TH FLOOR, ATTENTION OF: AMANDA MCFAYDEN
AMHERST NY
14226-1727
US

IV. Provider business mailing address

3980 SHERIDAN DR 6TH FLOOR, ATTENTION OF: AMANDA MCFAYDEN
AMHERST NY
14226-1727
US

V. Phone/Fax

Practice location:
  • Phone: 716-250-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number280893-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number280893-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: