Healthcare Provider Details

I. General information

NPI: 1093392136
Provider Name (Legal Business Name): NISHA ALTAF QAZI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HOSPITAL DR
UTICA NY
13502-2517
US

IV. Provider business mailing address

111 HOSPITAL DR
UTICA NY
13502-2517
US

V. Phone/Fax

Practice location:
  • Phone: 315-917-8440
  • Fax: 315-917-8808
Mailing address:
  • Phone: 315-917-9966
  • Fax: 315-624-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA12288100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number346363
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number346363
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: