Provider Demographics
NPI:1063682565
Name:GEORGE JOHN AYYAD PHYSICIAN PC
Entity Type:Organization
Organization Name:GEORGE JOHN AYYAD PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:AYYAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-727-1644
Mailing Address - Street 1:1800 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1616
Mailing Address - Country:US
Mailing Address - Phone:718-727-1644
Mailing Address - Fax:718-727-7365
Practice Address - Street 1:1800 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1616
Practice Address - Country:US
Practice Address - Phone:718-727-1644
Practice Address - Fax:718-727-7365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY25F223Medicare PIN
NYWAW911Medicare PIN