Provider Demographics
NPI:1255349932
Name:MUSTAFA, SYED IZHAR (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:IZHAR
Last Name:MUSTAFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PINEWILD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-4200
Mailing Address - Country:US
Mailing Address - Phone:585-368-6700
Mailing Address - Fax:585-368-6767
Practice Address - Street 1:100 PINEWILD DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4200
Practice Address - Country:US
Practice Address - Phone:585-368-6700
Practice Address - Fax:585-368-6767
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1797732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP020179773OtherBLUE SHIELD
NY102610EUOtherPREFERRED CARE
NY5006626OtherAETNA
NYE71008Medicare ID - Type UnspecifiedPARK RIDGE 70008A
NYP020179773OtherBLUE SHIELD
NYRA6801Medicare ID - Type UnspecifiedUMG BA0017