Healthcare Provider Details

I. General information

NPI: 1639747660
Provider Name (Legal Business Name): DELARAM MIRZANIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 6TH AVE
BROOKLYN NY
11209-3315
US

IV. Provider business mailing address

7501 6TH AVE
BROOKLYN NY
11209-3315
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-4385
  • Fax:
Mailing address:
  • Phone: 734-764-4190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4351047397
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: