Active NPI
Faisal Z. Mirza, D.D.S.
- General Practice Dentistry
- Brooklyn, NY
National Provider Identifier
1720209174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 053001-1
- Practice address
- 1276 Fulton St
2ND Floor
Brooklyn, NY 11216-2003 - Phone
- (718) 789-0909
- Fax
- (718) 789-6969
- NPI assigned
- May 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 053001-1 | NY | Primary |
Addresses
Primary practice location
1276 Fulton St
2ND Floor
Brooklyn, NY 11216-2003
Mailing address
423 E 90TH St
8B
New York, NY 10128-4236
Phone (718) 789-0909
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 67425040 | 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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 053001-1 | NY | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1720209174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "423 E 90TH ST",
"address_2": "8B",
"city": "NEW YORK",
"state": "NY",
"postal_code": "101284236",
"telephone_number": "718-789-0909",
"fax_number": "718-789-6969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1276 FULTON ST",
"address_2": "2ND FLOOR",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112162003",
"telephone_number": "718-789-0909",
"fax_number": "718-789-6969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIRZA",
"first_name": "FAISAL",
"middle_name": "Z.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NY",
"license": "053001-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "67425040",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.