Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 310966 | NY |
NPI | 1043449036 |
---|---|
Provider Name | Asim Mushtaq |
First Address | Rochester, NY 14617-5504 |
Second Address | Rochester, NY 14621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2009 |
Last Update Date | 26/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1530360 | (05) | TN |
6035999 | BCBS (01) | TN |
7100221700 | (05) | KY |