Healthcare Provider Details

I. General information

NPI: 1992701510
Provider Name (Legal Business Name): BATAVIA INTERNAL MEDICINE ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 SWAN ST STE 3
BATAVIA NY
14020-3232
US

IV. Provider business mailing address

34 SWAN ST STE 3
BATAVIA NY
14020-3232
US

V. Phone/Fax

Practice location:
  • Phone: 585-343-4441
  • Fax: 585-345-1590
Mailing address:
  • Phone: 585-343-4441
  • Fax: 585-345-1590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number190901-1 & 211016-1
License Number StateNY

VIII. Authorized Official

Name: JAVEED A MIR
Title or Position: PARTNER
Credential: MD
Phone: 585-343-4441