Provider Demographics
NPI:1144779620
Name:ASADUR MIAH PHYSICIAN PC
Entity Type:Organization
Organization Name:ASADUR MIAH PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ASADUR
Authorized Official - Middle Name:
Authorized Official - Last Name:MIAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-775-7112
Mailing Address - Street 1:1575 HILLSIDE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2521
Mailing Address - Country:US
Mailing Address - Phone:516-775-7112
Mailing Address - Fax:
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2521
Practice Address - Country:US
Practice Address - Phone:516-775-7112
Practice Address - Fax:516-775-9019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200941207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty