Basic Information
| Provider Information | |||||||||
| NPI: | 1508043621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIAN | ||||||||
| FirstName: | IFTIKHAR | ||||||||
| MiddleName: | AHMAD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHYSICIANS ASSISTANT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 COMMUNITY DRIVE | ||||||||
| Address2: | NS LIJ HEALTH SYSTEM | ||||||||
| City: | G NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164651900 | ||||||||
| FaxNumber: | 5164651830 | ||||||||
| Practice Location | |||||||||
| Address1: | 270-05 76TH AVE | ||||||||
| Address2: | NS LIJ HOSPITAL HEALTH SYSTEM | ||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184707270 | ||||||||
| FaxNumber: | 7184700827 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2008 | ||||||||
| LastUpdateDate: | 01/31/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 003554 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.