Provider Demographics
NPI:1952645434
Name:MIRZA, SOBIA NAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:SOBIA
Middle Name:NAZ
Last Name:MIRZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SOBIA
Other - Middle Name:
Other - Last Name:NAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-762-2340
Mailing Address - Fax:607-762-3298
Practice Address - Street 1:33 MITCHELL AVE
Practice Address - Street 2:SUITE G-80
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1642
Practice Address - Country:US
Practice Address - Phone:607-762-2340
Practice Address - Fax:607-762-3298
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2676482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry