Provider Demographics
NPI:1083659452
Name:AYYAD, GEORGE J (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:AYYAD
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 1:1800 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174696207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01725451Medicaid
NY01725451Medicaid
NYE17276Medicare UPIN
NY25F223Medicare ID - Type Unspecified