Provider Demographics
NPI:1366975831
Name:DOW BEHAVIORAL HEALTH MEDICAL PC
Entity type:Organization
Organization Name:DOW BEHAVIORAL HEALTH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-650-7221
Mailing Address - Street 1:63 SHAKER RD
Mailing Address - Street 2:SUITE G05
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12204-1025
Mailing Address - Country:US
Mailing Address - Phone:518-650-7221
Mailing Address - Fax:518-650-7274
Practice Address - Street 1:63 SHAKER RD
Practice Address - Street 2:SUITE G05
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1025
Practice Address - Country:US
Practice Address - Phone:518-650-7221
Practice Address - Fax:518-650-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicare PIN