Provider Demographics
NPI:1245295492
Name:WANI, ROZY NELOFAR (MD)
Entity type:Individual
Prefix:
First Name:ROZY
Middle Name:NELOFAR
Last Name:WANI
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 1:34 SWAN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:229 SUMMIT ST STE 1
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1645
Practice Address - Country:US
Practice Address - Phone:585-343-4440
Practice Address - Fax:585-343-0381
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211016207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01948645Medicaid
NY01948645Medicaid
NYG86675Medicare UPIN