Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 1235627472 | NY |
NPI | 1235627472 |
---|---|
Provider Name | Tariq Jamal Ahmed |
First Address | Rochester, NY 14605-2199 |
Second Address | Rochester, NY 14605-2199 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2018 |
Last Update Date | 18/08/2021 |