Healthcare Provider Details

I. General information

NPI: 1932014875
Provider Name (Legal Business Name): MARYAM ANSARI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24825 NORTHERN BLVD STE 1J
LITTLE NECK NY
11362-1280
US

IV. Provider business mailing address

24825 NORTHERN BLVD STE 1J
LITTLE NECK NY
11362-1280
US

V. Phone/Fax

Practice location:
  • Phone: 631-308-6453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF359596
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: