Healthcare Provider Details

I. General information

NPI: 1689361792
Provider Name (Legal Business Name): AHSAN AYAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MONTEFIORE ST LUKE'S CORNWALL 70 DUBOIS STREET
NEWBURGH NY
12553
US

IV. Provider business mailing address

MONTEFIORE ST LUKE'S CORNWALL 70 DUBOIS STREET
NEWBURGH NY
12553
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-4400
  • Fax:
Mailing address:
  • Phone: 845-561-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number79206
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: