Provider Demographics
NPI:1346695764
Name:AYUB, TAHIR
Entity Type:Individual
Prefix:
First Name:TAHIR
Middle Name:
Last Name:AYUB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 IRISH SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-5947
Mailing Address - Country:US
Mailing Address - Phone:518-310-3444
Mailing Address - Fax:518-310-3445
Practice Address - Street 1:286 IRISH SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-5947
Practice Address - Country:US
Practice Address - Phone:518-310-3444
Practice Address - Fax:518-310-3445
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03969500Medicaid