Healthcare Provider Details

I. General information

NPI: 1548455603
Provider Name (Legal Business Name): OBGYN OF SIDNEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 PEARL ST W
SIDNEY NY
13838-1325
US

IV. Provider business mailing address

44 PEARL ST W
SIDNEY NY
13838-1325
US

V. Phone/Fax

Practice location:
  • Phone: 607-563-9490
  • Fax:
Mailing address:
  • Phone: 607-563-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number128379
License Number StateNY

VIII. Authorized Official

Name: KHALID PARWEZ
Title or Position: OWNER
Credential: MD
Phone: 607-564-9490