Provider Demographics
NPI:1801093505
Name:ASIF, REHAN BIN (MD)
Entity type:Individual
Prefix:
First Name:REHAN
Middle Name:BIN
Last Name:ASIF
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 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-4200
Mailing Address - Fax:585-922-4922
Practice Address - Street 1:1415 PORTLAND AVE STE 490
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3022
Practice Address - Country:US
Practice Address - Phone:585-922-4200
Practice Address - Fax:585-922-4922
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003560207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03262553Medicaid
NYJ400069172Medicare PIN
NY10712AMedicare PIN
NY70005AMedicare PIN
NYJ400036641Medicare PIN