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General NPI Number Information
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NPI Number | 1205261161
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Entity Type | Individual
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Provider Name | TABASUM MIR M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 501 5TH AVE RM 602
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City | NEW YORK
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State | NY
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Zip | 10017-7831
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Country | US
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Telephone | 212-219-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 501 5TH AVE RM 602
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City | NEW YORK
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State | NY
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Zip | 10017-7831
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Country | US
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Telephone | 212-210-9272
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME159833
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | BM8695578
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License Number State | NY
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