Provider Demographics
NPI:1922254408
Name:RIZWANA, RABIA (MD)
Entity Type:Individual
Prefix:DR
First Name:RABIA
Middle Name:
Last Name:RIZWANA
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 1:1101 ERIE BLVD E
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1148
Mailing Address - Country:US
Mailing Address - Phone:315-472-9554
Mailing Address - Fax:315-472-9553
Practice Address - Street 1:1101 ERIE BLVD E
Practice Address - Street 2:SUITE 204
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1148
Practice Address - Country:US
Practice Address - Phone:315-472-9554
Practice Address - Fax:315-472-9553
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2526522084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03117219Medicaid
NYJ400030371Medicare PIN