Healthcare Provider Details

I. General information

NPI: 1508871328
Provider Name (Legal Business Name): SAQUIB IBRAHIM, PHYSICIAN, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 FOOTE AVE
JAMESTOWN NY
14701-7077
US

IV. Provider business mailing address

PO BOX 41
JAMESTOWN NY
14702-0041
US

V. Phone/Fax

Practice location:
  • Phone: 716-487-0141
  • Fax:
Mailing address:
  • Phone: 716-487-1124
  • Fax: 716-487-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAQUIB IBRAHIM
Title or Position: PRESIDENT
Credential: MD
Phone: 716-487-1124