Healthcare Provider Details

I. General information

NPI: 1205243557
Provider Name (Legal Business Name): ZEESHAN MOHAMMAD SARDAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST PH 11-102
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

5141 BROADWAY
NEW YORK NY
10034-1159
US

V. Phone/Fax

Practice location:
  • Phone: 212-932-5187
  • Fax: 212-932-5097
Mailing address:
  • Phone: 212-932-5187
  • Fax: 646-317-1288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number280620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: