Provider Demographics
NPI:1528054210
Name:HUMAYUN, NAEEM U (MBBS)
Entity type:Individual
Prefix:
First Name:NAEEM
Middle Name:U
Last Name:HUMAYUN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PROSPECT AVE
Mailing Address - Street 2:HOSPITAL INTERNISTS
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1807
Mailing Address - Country:US
Mailing Address - Phone:315-448-5704
Mailing Address - Fax:315-423-6853
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:HOSPITAL INTERNISTS
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5704
Practice Address - Fax:315-423-6853
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225097207R00000X, 208M00000X
CT045771207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001457712Medicaid
NY02662013Medicaid
NYRA8825Medicare PIN
I08173Medicare UPIN
NYRA7678Medicare ID - Type Unspecified
CT110010461 (C00814)Medicare PIN
NYJ400003727Medicare PIN