Provider Demographics
NPI:1164623633
Name:SIALA, TAREK M (RPA-C)
Entity Type:Individual
Prefix:
First Name:TAREK
Middle Name:M
Last Name:SIALA
Suffix:
Gender:M
Credentials:RPA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 629
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-758-5700
Mailing Address - Fax:585-758-1299
Practice Address - Street 1:2365 SOUTH CLINTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2663
Practice Address - Country:US
Practice Address - Phone:585-758-5700
Practice Address - Fax:585-758-1299
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2023-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY15149363AM0700X
NY015149363AM0700X
MAPA3914363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400067274Medicare PIN