Healthcare Provider Details

I. General information

NPI: 1760834600
Provider Name (Legal Business Name): HAFSA TARIQ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2016
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

39 GAGE GDNS
CHURCHVILLE NY
14428-9664
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-5123
  • Fax:
Mailing address:
  • Phone: 832-771-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number318344
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: