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General NPI Number Information
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NPI Number | 1003916628
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Entity Type | Individual
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Provider Name | MOHAMMAD ANSARI M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1335 ROUTE 44
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City | PLEASANT VALLEY
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State | NY
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Zip | 12569-7825
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Country | US
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Telephone | 845-635-8789
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Fax | 845-635-2141
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Provider Business Mailing Address
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Address Line | 42 SHAKER LN
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City | HYDE PARK
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State | NY
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Zip | 12538-3116
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Country | US
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Telephone | 845-233-4016
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 123867
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License Number State | NY
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