Healthcare Provider Details

I. General information

NPI: 1558630715
Provider Name (Legal Business Name): TOSEEF JAVAID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2011
Last Update Date: 07/14/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MITCHELL AVE 3RD FL
BINGHAMTON NY
13903
US

IV. Provider business mailing address

33 LEWIS RD FL 2
BINGHAMTON NY
13905
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-0639
  • Fax: 607-722-4610
Mailing address:
  • Phone: 607-770-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35124454
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number322121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: