Provider Demographics
NPI:1043449036
Name:MUSHTAQ, ASIM (MD)
Entity Type:Individual
Prefix:
First Name:ASIM
Middle Name:
Last Name:MUSHTAQ
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 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-4136
Mailing Address - Fax:585-922-5761
Practice Address - Street 1:1425 PORTLAND AVE; WILSON BUILDING
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-922-4136
Practice Address - Fax:585-922-5761
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48460208M00000X
NY310966207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530360Medicaid
KY7100221700Medicaid
TN6035999OtherBCBS