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General NPI Number Information
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NPI Number | 1922385582
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Entity Type | Organization
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Legal Business Name | SYED EAJAZUL HAQ PC
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Dates
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Enumeration Date | 11/10/2011
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 474 NIAGARA FALLS BLVD SUITE 4
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City | TONAWANDA
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State | NY
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Zip | 14223-2647
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Country | US
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Telephone | 716-833-3697
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Fax | 716-833-3698
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Provider Business Mailing Address
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Address Line | 474 NIAGARA FALLS BLVD SUITE 4
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City | TONAWANDA
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State | NY
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Zip | 14223-2647
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Country | US
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Telephone | 716-833-3697
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Fax | 716-833-3698
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EAJAZ H SYED
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Credential | MD
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Telephone | 716-833-3697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 119740
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License Number State | NY
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