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General NPI Number Information
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NPI Number | 1427379932
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Entity Type | Organization
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Legal Business Name | BAY SHORE MEDICAL SERVICES, P.C.
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 06/18/2010
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Provider Practice Location Address
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Address Line | 56 W MAIN ST # A
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City | BAY SHORE
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State | NY
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Zip | 11706-8327
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Country | US
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Telephone | 631-665-2288
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Fax |
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Provider Business Mailing Address
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Address Line | 56 W MAIN ST # A
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City | BAY SHORE
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State | NY
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Zip | 11706-8327
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Country | US
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Telephone | 631-665-2288
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SYED NISAR AHMAD
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Credential | M.D.
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Telephone | 631-665-2288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 1462241
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License Number State | NY
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