1649439399 NPI number — DR. IBRAHIM MOHAMMAD MIAN MD

Table of content: DR. IBRAHIM MOHAMMAD MIAN MD (NPI 1649439399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649439399 NPI number — DR. IBRAHIM MOHAMMAD MIAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MIAN
Provider First Name:
IBRAHIM
Provider Middle Name:
MOHAMMAD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIAN
Provider Other First Name:
MOHAMMAD
Provider Other Middle Name:
IBRAHIM
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1649439399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 BROADWAY RM 1750
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10279-1802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
580-297-9296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
233 BROADWAY RM 1750
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10279-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-671-5041
Provider Business Practice Location Address Fax Number:
580-297-9296
Provider Enumeration Date:
06/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  277398 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)