Healthcare Provider Details

I. General information

NPI: 1477543502
Provider Name (Legal Business Name): AHSAN NAZIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 12/16/2023
Certification Date: 12/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18911 JAMAICA AVE
HOLLIS NY
11423
US

IV. Provider business mailing address

18911 JAMAICA AVE
HOLLIS NY
11423-2513
US

V. Phone/Fax

Practice location:
  • Phone: 718-479-1100
  • Fax: 718-479-1103
Mailing address:
  • Phone: 516-640-5402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number207297
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: