Provider Demographics
NPI:1437247749
Name:M ZAEEM ANSARI, M.D., P.C.
Entity Type:Organization
Organization Name:M ZAEEM ANSARI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-593-2010
Mailing Address - Street 1:522 S 4TH ST
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-2946
Mailing Address - Country:US
Mailing Address - Phone:315-593-2010
Mailing Address - Fax:315-593-2047
Practice Address - Street 1:522 S 4TH ST
Practice Address - Street 2:SUITE 1500
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2946
Practice Address - Country:US
Practice Address - Phone:315-593-2010
Practice Address - Fax:315-593-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114948207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00569571Medicaid
NYD73996Medicare UPIN
NY00569571Medicaid
NY56133AMedicare ID - Type UnspecifiedGROUP NUMBER