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General NPI Number Information
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NPI Number | 1043881196
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Entity Type | Organization
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Legal Business Name | MIRZA ORTHOPEDICS PC
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 290 E MAIN ST
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City | SMITHTOWN
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State | NY
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Zip | 11787-2916
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Country | US
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Telephone | 631-361-5302
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Fax | 631-361-8607
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Provider Business Mailing Address
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Address Line | 994 W JERICHO TPKE STE 202A
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City | SMITHTOWN
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State | NY
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Zip | 11787-3211
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Country | US
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Telephone | 631-670-7700
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Fax | 631-343-7760
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Authorized Official
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Title or Position | CREDENTIALING ADMIN
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Name | MICHELLE CLANCY
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Credential |
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Telephone | 631-670-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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