Healthcare Provider Details

I. General information

NPI: 1629633201
Provider Name (Legal Business Name): MUHAMMAD RAFAY KHAN NIAZI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 04/29/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVENUE 2ND FL HEART TOWER
STATEN ISLAND NY
10305
US

IV. Provider business mailing address

475 SEAVIEW AVENUE 2ND FL HEART TOWER
STATEN ISLAND NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-8313
  • Fax:
Mailing address:
  • Phone: 718-226-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number318570-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD28717
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number318570-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: