MEDICARE: DR. FAISAL Z. MIRZA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	053001-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720209174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAISAL Z. MIRZA D.D.S.

Provider Business Mailing Address
First Line	:	423 E 90TH ST
Second Line	:	8B
City	:	NEW YORK
State	:	NY
Zip	:	10128-4236
Country	:	US
Telephone Number	:	718-789-0909
Fax Number	:	718-789-6969

Provider Business Practice Location Address
First Line	:	1276 FULTON ST
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11216-2003
Country	:	US
Telephone Number	:	718-789-0909
Fax Number	:	718-789-6969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/09/2007

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