MEDICARE: MIRZA ADNAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	P125651	NY

General Provider Information

NPI Number	:	1083489843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRZA ADNAN

Provider Business Mailing Address
First Line	:	482 GENESEE AVE FL 1
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3206
Country	:	US
Telephone Number	:	347-662-9009
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 E CRESCENT AVE STE 305
Second Line	:
City	:	UPPER SADDLE RIVER
State	:	NJ
Zip	:	07458-1846
Country	:	US
Telephone Number	:	845-738-8770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

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Directions to “ MIRZA ADNAN ” Practice Location

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