Healthcare Provider Details

I. General information

NPI: 1649351289
Provider Name (Legal Business Name): MOHSEN RAYMOND NAASSANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: M. RAYMOND NAASSANA M.D.

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33-57 HARRISON ST
JOHNSON CITY NY
13790-2107
US

IV. Provider business mailing address

PO BOX 8
HENRIETTA NY
14467-0008
US

V. Phone/Fax

Practice location:
  • Phone: 585-292-5170
  • Fax:
Mailing address:
  • Phone: 585-292-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number169785
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: