Healthcare Provider Details

I. General information

NPI: 1346703550
Provider Name (Legal Business Name): NIFRAN TIWARY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2019
Last Update Date: 04/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10818 QUEENS BLVD FL 5
FOREST HILLS NY
11375-4748
US

IV. Provider business mailing address

10415 142ND ST
JAMAICA NY
11435-5027
US

V. Phone/Fax

Practice location:
  • Phone: 212-804-7659
  • Fax: 888-975-7704
Mailing address:
  • Phone: 347-603-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: