Healthcare Provider Details

I. General information

NPI: 1962872812
Provider Name (Legal Business Name): AMER ALI MUSLEH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 LAKE AVE
ROCHESTER NY
14608-1162
US

IV. Provider business mailing address

214C LAKE AVE
ROCHESTER NY
14608-1208
US

V. Phone/Fax

Practice location:
  • Phone: 585-254-6480
  • Fax: 585-254-1092
Mailing address:
  • Phone: 585-423-5800
  • Fax: 585-423-2890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number019137
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: