Provider Demographics
NPI:1417102849
Name:EHTESHAM, NADIRA ISLAM
Entity Type:Individual
Prefix:DR
First Name:NADIRA
Middle Name:ISLAM
Last Name:EHTESHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DREISER LOOP
Mailing Address - Street 2:AREA C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475
Mailing Address - Country:US
Mailing Address - Phone:718-320-6300
Mailing Address - Fax:
Practice Address - Street 1:115 DREISER LOOP
Practice Address - Street 2:AREA C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475
Practice Address - Country:US
Practice Address - Phone:718-320-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1417102849OtherNPI