Healthcare Provider Details

I. General information

NPI: 1154285161
Provider Name (Legal Business Name): MISHGAN AZAM AKHTAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2054
US

IV. Provider business mailing address

543 NEWBRIDGE RD
EAST MEADOW NY
11554-5217
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-3325
  • Fax:
Mailing address:
  • Phone: 929-484-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2251P0200X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: