=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003099474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEBSTER PSYCHIATRY & MEDICINE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2007
-----------------------------------------------------
Last Update Date | 05/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1527 EMPIRE BLVD
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14580-2103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-670-0507
-----------------------------------------------------
Fax | 585-645-0939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1527 EMPIRE BLVD
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14580-2103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-670-0507
-----------------------------------------------------
Fax | 585-645-0939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND DIRECTOR
-----------------------------------------------------
Name | DR. SAHAR ELEZABI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 585-670-0507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 225834
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 225834
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------