Healthcare Provider Details

I. General information

NPI: 1508939190
Provider Name (Legal Business Name): MOHAMMAD ARSHAD MIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 STOCKHOLM ST
BROOKLYN NY
11237-4005
US

IV. Provider business mailing address

20 MILLAY RD
MORGANVILLE NJ
07751-1457
US

V. Phone/Fax

Practice location:
  • Phone: 718-366-4460
  • Fax: 718-366-8444
Mailing address:
  • Phone: 718-963-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number185231
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: