Provider Demographics
NPI:1477781763
Name:SYED, MANSOOR (OD)
Entity Type:Individual
Prefix:DR
First Name:MANSOOR
Middle Name:
Last Name:SYED
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SHELLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4719
Mailing Address - Country:US
Mailing Address - Phone:917-355-4884
Mailing Address - Fax:
Practice Address - Street 1:360 US HIGHWAY 9 N
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1004
Practice Address - Country:US
Practice Address - Phone:732-826-6932
Practice Address - Fax:732-826-6936
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007432-1152W00000X
NJ27OA00619200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist