Provider Demographics
NPI:1467512657
Name:NIZAMI, FARZANA (MD)
Entity Type:Individual
Prefix:DR
First Name:FARZANA
Middle Name:
Last Name:NIZAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17810 WEXFORD TER APT 2C
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3003
Mailing Address - Country:US
Mailing Address - Phone:718-291-0178
Mailing Address - Fax:
Practice Address - Street 1:8746 CHELSEA ST APT LC
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2400
Practice Address - Country:US
Practice Address - Phone:718-657-7900
Practice Address - Fax:718-657-7902
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02458831Medicaid
NY06023Medicare ID - Type Unspecified
NY02458831Medicaid