Provider Demographics
NPI:1376848960
Name:HABIB, AYAZ AHMED (DPM)
Entity Type:Individual
Prefix:DR
First Name:AYAZ
Middle Name:AHMED
Last Name:HABIB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 CLINTON AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2664
Mailing Address - Country:US
Mailing Address - Phone:585-473-5051
Mailing Address - Fax:585-473-3033
Practice Address - Street 1:6565 4TH SECTION RD
Practice Address - Street 2:SUITE 700
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-2414
Practice Address - Country:US
Practice Address - Phone:585-473-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6595213ES0131X
390200000X
NYN006595-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program