Healthcare Provider Details

I. General information

NPI: 1750242210
Provider Name (Legal Business Name): DR MIR UDDIN DPM MIR PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2025
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8746 168TH ST APT 3
JAMAICA NY
11432-3656
US

IV. Provider business mailing address

8746 168TH ST APT 3
JAMAICA NY
11432-3656
US

V. Phone/Fax

Practice location:
  • Phone: 646-687-2838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: NABEEL BABAR
Title or Position: ADMNISTRATOR
Credential:
Phone: 646-687-2838