Basic Information
| Provider Information | |||||||||
| NPI: | 1124189253 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LONE | ||||||||
| FirstName: | RIAZ | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 59 RIVER ST | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 138381035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075638022 | ||||||||
| FaxNumber: | 6075638106 | ||||||||
| Practice Location | |||||||||
| Address1: | 59 RIVER ST | ||||||||
| Address2: | |||||||||
| City: | SIDNEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 138381035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075638022 | ||||||||
| FaxNumber: | 6075638106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 05/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 144364 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207R00000X | 144364 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00771384 | 05 | NY | MEDICAID |