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General NPI Number Information
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NPI Number | 1689463713
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Entity Type | Organization
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Legal Business Name | MIRZA MEDICAL SERVICES PLLC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 25913 HILLSIDE AVE
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City | FLORAL PARK
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State | NY
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Zip | 11004-1622
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Country | US
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Telephone | 516-321-0956
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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 | 516-808-2535
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABDUL-SAMAD MIRZA
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Credential | MD,DO
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Telephone | 516-808-2535
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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 |
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License Number State |
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