Provider Demographics
NPI:1467417683
Name:MIR, JAVEED A (MD)
Entity Type:Individual
Prefix:DR
First Name:JAVEED
Middle Name:A
Last Name:MIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SWAN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 SWAN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3232
Practice Address - Country:US
Practice Address - Phone:585-343-4441
Practice Address - Fax:585-345-1590
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1909011207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01547373Medicaid
NYF48031Medicare UPIN
NYAA1545Medicare ID - Type Unspecified