Healthcare Provider Details

I. General information

NPI: 1932765310
Provider Name (Legal Business Name): JAWARYA SAFDAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2019
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COMMUNITY DR
MANHASSET NY
11030-3816
US

IV. Provider business mailing address

11600 S KEDZIE AVE STE D
MERRIONETTE PARK IL
60803-6307
US

V. Phone/Fax

Practice location:
  • Phone: 516-823-8821
  • Fax:
Mailing address:
  • Phone: 708-684-5032
  • Fax: 708-684-3142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number326202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: