Healthcare Provider Details

I. General information

NPI: 1104088780
Provider Name (Legal Business Name): NIMRA SARFARAZ D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2038 HILLSIDE AVE STE 2149
NEW HYDE PARK NY
11040-2613
US

IV. Provider business mailing address

PO BOX 2149
NEW HYDE PARK NY
11040-8149
US

V. Phone/Fax

Practice location:
  • Phone: 516-519-3959
  • Fax:
Mailing address:
  • Phone: 516-519-3959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMED-PHYS-LIC-175009
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number261663
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC6053
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2023034176
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number261663
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR0654
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: