Provider Demographics
NPI:1508043621
Name:MIAN, IFTIKHAR AHMAD (PHYSICIANS ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:IFTIKHAR
Middle Name:AHMAD
Last Name:MIAN
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Gender:M
Credentials:PHYSICIANS ASSISTANT
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Mailing Address - Street 1:175 COMMUNITY DRIVE
Mailing Address - Street 2:NS LIJ HEALTH SYSTEM
Mailing Address - City:G NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-465-1900
Mailing Address - Fax:516-465-1830
Practice Address - Street 1:270-05 76TH AVE
Practice Address - Street 2:NS LIJ HOSPITAL HEALTH SYSTEM
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:718-470-7270
Practice Address - Fax:718-470-0827
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
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Provider Licenses
StateLicense IDTaxonomies
NY003554363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical