Provider Demographics
NPI:1508939190
Name:MIR, MOHAMMAD ARSHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ARSHAD
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 1:20 MILLAY RD
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1457
Mailing Address - Country:US
Mailing Address - Phone:718-963-7117
Mailing Address - Fax:
Practice Address - Street 1:365 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4005
Practice Address - Country:US
Practice Address - Phone:718-366-4460
Practice Address - Fax:718-366-8444
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185231208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00G462OtherBLUE CROSS BLUE SHIELD
NY01252368Medicaid
NYE97221Medicare UPIN