Basic Information
| Provider Information | |||||||||
| NPI: | 1396724357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIQDADI | ||||||||
| FirstName: | JEHAD | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 ESSJAY RD STE 170 | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142215782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166301219 | ||||||||
| FaxNumber: | 7168171726 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166312517 | ||||||||
| FaxNumber: | 7166345650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 12/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 233691-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 000524480005 | 01 | NY | HEALTH NOW | OTHER | 00481838 | 05 | NY | MEDICAID | 161000580 | 01 | NY | EMPIRE PLAN | OTHER | 408648 | 01 | NY | IHA | OTHER | 161000580 | 01 | NY | NORTH AMERICAN PREFERRED | OTHER | 161000580 | 01 | NY | GHI | OTHER | 161000580 | 01 | NY | AETNA | OTHER | 00010290905 | 01 | NY | UNIVERA | OTHER | 161000580 | 01 | NY | NOVA | OTHER | PO00110477 | 01 | NY | RR MEDICARE | OTHER |