Provider Demographics
NPI:1952012353
Name:SHIRAJ, SAMIRA (MD)
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:
Last Name:SHIRAJ
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 1:7112 BOULEVARD E APT 5F
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5956
Mailing Address - Country:US
Mailing Address - Phone:216-456-5963
Mailing Address - Fax:
Practice Address - Street 1:1339 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4707
Practice Address - Country:US
Practice Address - Phone:212-628-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP118715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine