Provider Demographics
NPI:1376714469
Name:MIR, WASEEM (MD)
Entity Type:Individual
Prefix:
First Name:WASEEM
Middle Name:
Last Name:MIR
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 1:845 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5450
Mailing Address - Country:US
Mailing Address - Phone:212-288-3280
Mailing Address - Fax:877-769-7892
Practice Address - Street 1:50 E 81ST ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0248
Practice Address - Country:US
Practice Address - Phone:212-288-3280
Practice Address - Fax:877-769-7892
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist