Provider Demographics
NPI:1497715296
Name:RAZA, SYED HASAN (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:HASAN
Last Name:RAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 PARK AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1740
Mailing Address - Country:US
Mailing Address - Phone:585-798-4108
Mailing Address - Fax:585-798-4894
Practice Address - Street 1:711 PARK AVE STE 202
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1740
Practice Address - Country:US
Practice Address - Phone:585-798-4108
Practice Address - Fax:585-798-4894
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010000452OtherBLUE CHOICE
NY0409179OtherINDEPENDENT HEALTH
NY01689312Medicaid
NY01689312Medicaid