MEDICARE: PRR DIAGNOSTIC MEDICINE PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician	NY
2	208D00000X	General Practice Physician
3	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1780086363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRR DIAGNOSTIC MEDICINE PC

Provider Business Mailing Address
First Line	:	1265 CLOVE RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-4339
Country	:	US
Telephone Number	:	973-493-7607
Fax Number	:	914-470-5056

Provider Business Practice Location Address
First Line	:	1265 CLOVE RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-4339
Country	:	US
Telephone Number	:	973-493-7607
Fax Number	:	914-470-5056

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MUHAMMAD MIRZA
Credential	:	MD
Telephone Number	:	973-493-7607

Provider Enumeration Date	:	09/25/2014
Last Update Date	:	09/25/2014

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