Provider Demographics
NPI:1063590115
Name:NIZAR, AHMED R (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:R
Last Name:NIZAR
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 1:742 JAMES ST
Mailing Address - Street 2:OUTPATIENT MENTAL HEALTH SERVICES
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2017
Mailing Address - Country:US
Mailing Address - Phone:315-703-2700
Mailing Address - Fax:315-703-2700
Practice Address - Street 1:742 JAMES ST
Practice Address - Street 2:OUTPATIENT MENTAL HEALTH SERVICES
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2017
Practice Address - Country:US
Practice Address - Phone:315-703-2700
Practice Address - Fax:315-703-2700
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002475-12084P0802X
NY2599832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8832Medicare PIN
NYJ400087018Medicare PIN