Basic Information
| Provider Information | |||||||||
| NPI: | 1518930965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REHMAN | ||||||||
| FirstName: | FAZALUR | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 565 ABBOTT RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142202039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168282169 | ||||||||
| FaxNumber: | 7166892238 | ||||||||
| Practice Location | |||||||||
| Address1: | 565 ABBOTT RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142202039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168282169 | ||||||||
| FaxNumber: | 7166892238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | 167690-1 | NY | Y | Allopathic & Osteopathic Physicians | Nuclear Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00010146504 | 01 | UNIVERA | OTHER | 360004070 | 01 | RAILROAD MEDICARE | OTHER | 000510930011 | 01 | BLUE SHIELD OF WESTERN NY | OTHER | CNUM1676907 | 01 | NY | WORKERS COMPENSATION | OTHER | 000510930015 | 01 | BLUE SHIELD OF WESTERN NY | OTHER | 040426001884 | 01 | FIDELIS | OTHER | 4903079 | 01 | INDEPENDANT HEALTH | OTHER | P00061128 | 01 | RAILROAD MEDICARE | OTHER | 01185088 | 05 | NY | MEDICAID | 01185097 | 05 | NY | MEDICAID | 040426001883 | 01 | FIDELIS | OTHER |