Healthcare Provider Details

I. General information

NPI: 1770553737
Provider Name (Legal Business Name): AMMAR KAFA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 MAPLE ST
MASSENA NY
13662-1012
US

IV. Provider business mailing address

1 HOSPITAL DR
MASSENA NY
13662-1056
US

V. Phone/Fax

Practice location:
  • Phone: 315-769-4704
  • Fax: 315-769-4315
Mailing address:
  • Phone: 315-769-4200
  • Fax: 317-769-4353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number270868
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: