=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295373306
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAZALI CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2019
-----------------------------------------------------
Last Update Date | 12/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 280 NORTH ST
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14605-2539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-507-0312
-----------------------------------------------------
Fax | 585-287-5529
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 BIRR ST
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14613-1736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-507-0312
-----------------------------------------------------
Fax | 585-287-5529
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | MR. MOHAMED GAZALI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 585-507-0312
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------