Provider Demographics
NPI:1306943113
Name:MOHAMED, ZOSER ZAKARIA (MD)
Entity type:Individual
Prefix:DR
First Name:ZOSER
Middle Name:ZAKARIA
Last Name:MOHAMED
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:PO BOX 9202
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-0202
Mailing Address - Country:US
Mailing Address - Phone:518-377-5948
Mailing Address - Fax:518-377-0037
Practice Address - Street 1:1538 UNION ST
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-6002
Practice Address - Country:US
Practice Address - Phone:518-377-5948
Practice Address - Fax:518-377-0037
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
NY169917-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000470705001OtherBLUE SHIELD
NY0066417002OtherGHI
NY20138OtherMVP
NY69E05OtherBLUE CROSS
NY10001401OtherCDPHP
NY56605OtherCIGNA
NY0066417002OtherGHI
NY20138OtherMVP