Provider Demographics
NPI:1558318550
Name:AFZAL, SYED
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:
Last Name:AFZAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 RXR PLZ
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556-1301
Mailing Address - Country:US
Mailing Address - Phone:516-453-0435
Mailing Address - Fax:
Practice Address - Street 1:39 CELANO LN
Practice Address - Street 2:
Practice Address - City:W ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-5105
Practice Address - Country:US
Practice Address - Phone:631-453-1286
Practice Address - Fax:631-453-1286
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01546767Medicaid
NY79J972Medicare ID - Type Unspecified
NYF95658Medicare UPIN