Provider Demographics
NPI:1598244212
Name:SYED SIRAJ MASOOD, MD, PC
Entity Type:Organization
Organization Name:SYED SIRAJ MASOOD, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:SIRAJ
Authorized Official - Last Name:MASOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-467-5957
Mailing Address - Street 1:1295 PORTLAND AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2726
Mailing Address - Country:US
Mailing Address - Phone:585-467-5957
Mailing Address - Fax:585-467-7445
Practice Address - Street 1:1295 PORTLAND AVE STE 17
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2726
Practice Address - Country:US
Practice Address - Phone:585-467-5957
Practice Address - Fax:585-467-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190369208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1851945Medicaid