=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437247749
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M ZAEEM ANSARI, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 11/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 522 S 4TH ST SUITE 1500
-----------------------------------------------------
City | FULTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13069-2946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-593-2010
-----------------------------------------------------
Fax | 315-593-2047
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 522 S 4TH ST SUITE 1500
-----------------------------------------------------
City | FULTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13069-2946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-593-2010
-----------------------------------------------------
Fax | 315-593-2047
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ZAEEM ANSARI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 315-593-2010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 114948
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------