=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932825643
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOHINUR FIRDAVSI PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2022
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 983 E 12TH ST BSMT
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11230-3667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-699-2807
-----------------------------------------------------
Fax | 917-591-3013
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2126 BENSON AVE APT 5A
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11214-5031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-988-1145
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 029384
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------