MEDICARE: SYED IZHAR MUSTAFA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	179773	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P020179773	OTHER	NY	BLUE SHIELD
2	102610EU	OTHER	NY	PREFERRED CARE
3	5006626	OTHER	NY	AETNA

General Provider Information

NPI Number	:	1255349932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYED IZHAR MUSTAFA MD

Provider Business Mailing Address
First Line	:	100 PINEWILD DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14606-4200
Country	:	US
Telephone Number	:	585-368-6700
Fax Number	:	585-368-6767

Provider Business Practice Location Address
First Line	:	100 PINEWILD DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14606-4200
Country	:	US
Telephone Number	:	585-368-6700
Fax Number	:	585-368-6767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/03/2023

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