Provider Demographics
NPI:1457604324
Name:IRFAN, BISMAH (MD)
Entity type:Individual
Prefix:
First Name:BISMAH
Middle Name:
Last Name:IRFAN
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 1:4256 BRONX BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2672
Mailing Address - Country:US
Mailing Address - Phone:718-690-3666
Mailing Address - Fax:855-816-0750
Practice Address - Street 1:4256 BRONX BLVD STE 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2672
Practice Address - Country:US
Practice Address - Phone:718-690-3666
Practice Address - Fax:855-816-0750
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125062109207R00000X
NY288212207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine