Provider Demographics
NPI:1306858469
Name:SARFARAZ, NASREEN SIDDIQUI (MD)
Entity Type:Individual
Prefix:DR
First Name:NASREEN
Middle Name:SIDDIQUI
Last Name:SARFARAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NASREEN
Other - Middle Name:
Other - Last Name:SIDDIQUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:62 DALEY ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3604
Mailing Address - Country:US
Mailing Address - Phone:718-454-1732
Mailing Address - Fax:718-454-1564
Practice Address - Street 1:19909 HILLSIDE AVE
Practice Address - Street 2:HOLLIS
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2130
Practice Address - Country:US
Practice Address - Phone:718-454-1732
Practice Address - Fax:718-454-1564
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0219479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02129179Medicaid
NYI 16919Medicare UPIN