Provider Demographics
NPI:1194822346
Name:HASSANALI, RIYAZ (MD)
Entity type:Individual
Prefix:DR
First Name:RIYAZ
Middle Name:
Last Name:HASSANALI
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 1:811 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3260
Mailing Address - Country:US
Mailing Address - Phone:716-626-1593
Mailing Address - Fax:
Practice Address - Street 1:811 MAPLE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3260
Practice Address - Country:US
Practice Address - Phone:716-626-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177607-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY177607-1OtherLICENSE#
NYHA282603OtherMEDICARE
NYE93589Medicare UPIN