Provider Demographics
NPI:1538129655
Name:BAKSHI, FOZIA (MD)
Entity Type:Individual
Prefix:
First Name:FOZIA
Middle Name:
Last Name:BAKSHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 KING ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-1142
Mailing Address - Country:US
Mailing Address - Phone:315-379-4700
Mailing Address - Fax:315-379-4900
Practice Address - Street 1:4811 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3629
Practice Address - Country:US
Practice Address - Phone:315-457-9966
Practice Address - Fax:315-379-4900
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202547208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222110646OtherBUSINESS TAX ID #