Active NPI
Fadi Mirza, M.D.
- Maternal & Fetal Medicine Physician
- New York, NY
National Provider Identifier
1396866968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Maternal & Fetal Medicine Physician
- License
- 003520
- Practice address
- 622 W 168TH St
PH 16-66
New York, NY 10032-3720 - Phone
- (212) 305-6293
- NPI assigned
- Apr 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Maternal & Fetal Medicine Physician | 207VM0101X | 003520 | NY | Primary |
Addresses
Primary practice location
622 W 168TH St
PH 16-66
New York, NY 10032-3720
Mailing address
622 W 168TH St
PH 16-66
New York, NY 10032-3720
Phone (212) 305-6293
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02248786 | Medicaid | NY | |
| 02559635 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003520 | NY | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trustees of Columbia University Dept of Obstetrics and Gynecology | Past | Accepting new patients | |
| Trustees of Columbia University Dept of Obstetrics and GYN Ultrasound | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Specialist
- New York, NY
- NPI 1366467243
-
- Obstetrics & Gynecology Physician
- New York, NY
- NPI 1154346021
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273622400000",
"number": "1396866968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "622 W 168TH ST",
"address_2": "PH 16-66",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323720",
"telephone_number": "212-305-6293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "622 W 168TH ST",
"address_2": "PH 16-66",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100323720",
"telephone_number": "212-305-6293"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRZA",
"first_name": "FADI",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-02",
"last_updated": "2010-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "207VM0101X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
"state": "NY",
"license": "003520",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02248786",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02559635",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.