MEDICARE: DR. RIYAD MOHAMMED ROUF M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	298015-1	NY
2	2084P0800X	Psychiatry Physician	298015	NY

General Provider Information

NPI Number	:	1598143323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RIYAD MOHAMMED ROUF M.D.

Provider Business Mailing Address
First Line	:	5 COMPUTER DR W STE 100-01
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-1613
Country	:	US
Telephone Number	:	516-200-4578
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 COMPUTER DR W STE 100-01
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-1613
Country	:	US
Telephone Number	:	516-200-4578
Fax Number	:

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

Provider Enumeration Date	:	05/13/2015
Last Update Date	:	03/20/2023

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