Provider Demographics
NPI:1124189253
Name:LONE, RIAZ A (MD)
Entity Type:Individual
Prefix:
First Name:RIAZ
Middle Name:A
Last Name:LONE
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 1:59 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1035
Mailing Address - Country:US
Mailing Address - Phone:607-563-8022
Mailing Address - Fax:607-563-8106
Practice Address - Street 1:59 RIVER ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1035
Practice Address - Country:US
Practice Address - Phone:607-563-8022
Practice Address - Fax:607-563-8106
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144364207RG0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00771384Medicaid
NYB79933Medicare UPIN
NY00771384Medicaid