Provider Demographics
NPI:1750378592
Name:NIHAMIN, FIRA (MD)
Entity type:Individual
Prefix:DR
First Name:FIRA
Middle Name:
Last Name:NIHAMIN
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 1:3965 52ND ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3254
Mailing Address - Country:US
Mailing Address - Phone:718-429-0039
Mailing Address - Fax:718-429-6965
Practice Address - Street 1:3965 52ND ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3254
Practice Address - Country:US
Practice Address - Phone:718-429-0039
Practice Address - Fax:718-429-6965
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00787884Medicaid
07915Medicare ID - Type Unspecified
NY00787884Medicaid