Provider Demographics
NPI:1972593903
Name:PERVEZ, YASMIN (MD)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:PERVEZ
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 1:525 WHEATFIELD ST
Mailing Address - Street 2:10
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-7034
Mailing Address - Country:US
Mailing Address - Phone:716-692-7156
Mailing Address - Fax:716-692-3388
Practice Address - Street 1:525 WHEATFIELD ST
Practice Address - Street 2:10
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-7034
Practice Address - Country:US
Practice Address - Phone:716-692-7156
Practice Address - Fax:716-692-3388
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2092161207R00000X
NY209216-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01795500Medicaid
NYG54779Medicare UPIN
NY01795500Medicaid