Provider Demographics
NPI:1225064322
Name:BEG, MIRZA SULEMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRZA
Middle Name:SULEMAN
Last Name:BEG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2036 SULTAN CIR
Mailing Address - Street 2:
Mailing Address - City:CHULUOTA
Mailing Address - State:FL
Mailing Address - Zip Code:32766-8429
Mailing Address - Country:US
Mailing Address - Phone:201-522-0646
Mailing Address - Fax:
Practice Address - Street 1:801 BEVILLE RD
Practice Address - Street 2:STE 101
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1861
Practice Address - Country:US
Practice Address - Phone:718-426-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2023032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG3602Medicare UPIN
NY11J601Medicare PIN