Provider Demographics
NPI:1205261161
Name:MIR, TABASUM (MD)
Entity type:Individual
Prefix:DR
First Name:TABASUM
Middle Name:
Last Name:MIR
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 1:501 5TH AVE RM 602
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-7831
Mailing Address - Country:US
Mailing Address - Phone:212-210-9272
Mailing Address - Fax:
Practice Address - Street 1:501 5TH AVE RM 602
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-7831
Practice Address - Country:US
Practice Address - Phone:212-219-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME159833208200000X
NYBM8695578208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery