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General NPI Number Information
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NPI Number | 1619430782
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Entity Type | Individual
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Provider Name | ABDUL-SAMAD MIRZA
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Gender | Male
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Dates
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Enumeration Date | 04/07/2019
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 107 MITCHEL FIELD WAY
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City | GARDEN CITY
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State | NY
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Zip | 11530-5034
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Country | US
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Telephone | 631-813-6869
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Fax |
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Provider Business Mailing Address
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Address Line | 107 MITCHEL FIELD WAY
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City | GARDEN CITY
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State | NY
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Zip | 11530-5034
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Country | US
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Telephone | 631-813-6869
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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 | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | OS18253
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 323388
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License Number State | NY
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