Provider Demographics
NPI:1992701510
Name:BATAVIA INTERNAL MEDICINE ASSOCIATES, PLLC
Entity type:Organization
Organization Name:BATAVIA INTERNAL MEDICINE ASSOCIATES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAVEED
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-343-4441
Mailing Address - Street 1:34 SWAN ST
Mailing Address - Street 2:STE 3
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3232
Mailing Address - Country:US
Mailing Address - Phone:585-343-4441
Mailing Address - Fax:585-345-1590
Practice Address - Street 1:34 SWAN ST
Practice Address - Street 2:STE 3
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3232
Practice Address - Country:US
Practice Address - Phone:585-343-4441
Practice Address - Fax:585-345-1590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190901-1 & 211016-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020552304OtherUNIVERA
NY000525640004OtherCOMM. BLUE
NY01948645Medicaid
NY2504379OtherGHI
NY2596786OtherGHI
NY000529997007OtherCOMM. BLUE
NYMDF289OtherPREFERRED CARE
NY01547373Medicaid
NY00010284803OtherUNIVERA
NY0409504OtherINDEPENDENT HEALTH
NYP010211016OtherBLUE CHOICE
NY0410492OtherINDEPENDENT HEALTH
NYMDB219OtherPREFERRED CARE
NYP010190901OtherBLUE CHOICE
NYMDF289OtherPREFERRED CARE
NY2504379OtherGHI