Provider Demographics
NPI:1396904728
Name:RAZA MEDICAL OFFICE PLLC
Entity type:Organization
Organization Name:RAZA MEDICAL OFFICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:HASAN
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-798-4108
Mailing Address - Street 1:711 PARK AVE, BUILDING 1, SUITE 202
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:NY
Mailing Address - Zip Code:14103-1740
Mailing Address - Country:US
Mailing Address - Phone:585-798-4108
Mailing Address - Fax:585-798-4894
Practice Address - Street 1:711 PARK AVE, BUILDING 1, SUITE 202
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1740
Practice Address - Country:US
Practice Address - Phone:585-798-4108
Practice Address - Fax:585-798-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14416AMedicare PIN