Provider Demographics
NPI:1710232582
Name:SIRAJ, AISHA (MD)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:SIRAJ
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 1:1770 GRAND CONCOURSE
Mailing Address - Street 2:APARTMENT 3 B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5524
Mailing Address - Country:US
Mailing Address - Phone:347-601-8409
Mailing Address - Fax:
Practice Address - Street 1:1770 GRAND CONCOURSE
Practice Address - Street 2:APARTMENT 3 B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5524
Practice Address - Country:US
Practice Address - Phone:347-601-8409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program