Provider Demographics
NPI:1023164571
Name:NEPHROLOGY SERVICES MEDICAL GROUP OF OLEAN & BRADFORD, PC
Entity type:Organization
Organization Name:NEPHROLOGY SERVICES MEDICAL GROUP OF OLEAN & BRADFORD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMED
Authorized Official - Middle Name:T
Authorized Official - Last Name:JAVED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-372-4212
Mailing Address - Street 1:PO BOX 583
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-0583
Mailing Address - Country:US
Mailing Address - Phone:716-372-4212
Mailing Address - Fax:716-373-9167
Practice Address - Street 1:623 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1515
Practice Address - Country:US
Practice Address - Phone:716-372-4212
Practice Address - Fax:716-373-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193890-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02353684Medicaid
NY01452253Medicaid
PA01546870Medicaid
PA796426Q2MMedicare ID - Type UnspecifiedMUHAMMED T JAVED PAMC
PA01546870Medicaid
NY02353684Medicaid
NYS80361Medicare UPIN
PA063497Medicare ID - Type UnspecifiedGROUP PAMC ID
NY01452253Medicaid
NYBB5218Medicare ID - Type UnspecifiedMUHAMMED T JAVED ID NYMC
NYAA0268Medicare ID - Type UnspecifiedGROUP MC NUMBER