Provider Demographics
NPI:1285829226
Name:SYED AFZAL M.D. P.C.
Entity Type:Organization
Organization Name:SYED AFZAL M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:AFZAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-434-5678
Mailing Address - Street 1:39 CELANO LN
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-5105
Mailing Address - Country:US
Mailing Address - Phone:718-434-5678
Mailing Address - Fax:718-744-0482
Practice Address - Street 1:1129 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4711
Practice Address - Country:US
Practice Address - Phone:718-434-5678
Practice Address - Fax:718-744-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01546767Medicaid
NY1558318550OtherNPI
NY197001OtherLICENSE
NY197001OtherLICENSE
NYF95658Medicare UPIN