Provider Demographics
NPI:1245349208
Name:BAYOUMI MEDICAL PLLC
Entity type:Organization
Organization Name:BAYOUMI MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:GAMAL
Authorized Official - Last Name:BAYOUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-786-2290
Mailing Address - Street 1:2261 ROUTE 19 N
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-9334
Mailing Address - Country:US
Mailing Address - Phone:585-786-2290
Mailing Address - Fax:585-786-2853
Practice Address - Street 1:2261 ROUTE 19 N
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-9334
Practice Address - Country:US
Practice Address - Phone:585-786-2290
Practice Address - Fax:585-786-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300945363LA2200X
NY210742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02833109Medicaid
NY01509493Medicaid
NY01861238Medicaid
NY02833109Medicaid
NYDD2098Medicare ID - Type UnspecifiedAHMED BAYOUMI
NYAA1293Medicare ID - Type UnspecifiedPRACTICE NUMBER