1720478373 NPI number — NIMRA SARFARAZ DO PLLC

Table of content: (NPI 1720478373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720478373 NPI number — NIMRA SARFARAZ DO PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NIMRA SARFARAZ DO PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720478373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2149
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-8149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-519-3959
Provider Business Mailing Address Fax Number:
718-454-1564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19909 HILLSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11423-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-454-1732
Provider Business Practice Location Address Fax Number:
718-454-1564
Provider Enumeration Date:
02/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SARFARAZ
Authorized Official First Name:
NIMRA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
516-519-3959

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  261663 , 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)

  • Identifier: 03366685 . This is a "PERSONNAL MEDICAID PROVIDED NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 261663 . This is a "NY STATE LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com