Provider Demographics
NPI:1720478373
Name:NIMRA SARFARAZ DO PLLC
Entity Type:Organization
Organization Name:NIMRA SARFARAZ DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NIMRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARFARAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-519-3959
Mailing Address - Street 1:PO BOX 2149
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-8149
Mailing Address - Country:US
Mailing Address - Phone:516-519-3959
Mailing Address - Fax:718-454-1564
Practice Address - Street 1:19909 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2130
Practice Address - Country:US
Practice Address - Phone:718-454-1732
Practice Address - Fax:718-454-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261663207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03366685OtherPERSONNAL MEDICAID PROVIDED NUMBER
NY261663OtherNY STATE LICENSE