Healthcare Provider Details

I. General information

NPI: 1558774968
Provider Name (Legal Business Name): SYEDA MARZIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 WINCHESTER BLVD
QUEENS VILLAGE NY
11427-2128
US

IV. Provider business mailing address

23 CELLER AVE
NEW HYDE PARK NY
11040-2014
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-7500
  • Fax:
Mailing address:
  • Phone: 347-926-8909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberS1861
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number283104-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: