Provider Demographics
NPI:1235191685
Name:NIA, KAMRAN VAZIR (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:VAZIR
Last Name:NIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10406 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6736
Mailing Address - Country:US
Mailing Address - Phone:718-275-8100
Mailing Address - Fax:718-793-5595
Practice Address - Street 1:10406 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6736
Practice Address - Country:US
Practice Address - Phone:718-275-8100
Practice Address - Fax:718-793-5595
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172501207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01053956Medicaid
NY36910Medicare ID - Type Unspecified
NYB58661Medicare UPIN