MEDICARE: SYED EAJAZUL HAQ PC

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	261QP2300X	Primary Care Clinic/Center	119740	NY

General Provider Information

NPI Number	:	1922385582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYED EAJAZUL HAQ PC

Provider Business Mailing Address
First Line	:	474 NIAGARA FALLS BLVD
Second Line	:	SUITE 4
City	:	TONAWANDA
State	:	NY
Zip	:	14223-2647
Country	:	US
Telephone Number	:	716-833-3697
Fax Number	:	716-833-3698

Provider Business Practice Location Address
First Line	:	474 NIAGARA FALLS BLVD
Second Line	:	SUITE 4
City	:	TONAWANDA
State	:	NY
Zip	:	14223-2647
Country	:	US
Telephone Number	:	716-833-3697
Fax Number	:	716-833-3698

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EAJAZ H SYED
Credential	:	MD
Telephone Number	:	716-833-3697

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	03/23/2012

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