Provider Demographics
NPI:1851564942
Name:MOHAMMED SEEDAT MD AND CORAL NICHOLAS MD PLLC
Entity Type:Organization
Organization Name:MOHAMMED SEEDAT MD AND CORAL NICHOLAS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEEDAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-336-3353
Mailing Address - Street 1:1316 BLACK RIVER BLVD N
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3601
Mailing Address - Country:US
Mailing Address - Phone:315-336-3353
Mailing Address - Fax:315-336-3356
Practice Address - Street 1:1316 BLACK RIVER BLVD N
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3601
Practice Address - Country:US
Practice Address - Phone:315-336-3353
Practice Address - Fax:315-336-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202800207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02731588Medicaid
Y50766Medicare UPIN
BA0798Medicare PIN