Provider Demographics
NPI:1437161262
Name:MISRA, SAMEER K (MD)
Entity type:Individual
Prefix:DR
First Name:SAMEER
Middle Name:K
Last Name:MISRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19602 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2125
Mailing Address - Country:US
Mailing Address - Phone:718-776-2061
Mailing Address - Fax:718-479-7012
Practice Address - Street 1:19602 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2125
Practice Address - Country:US
Practice Address - Phone:718-776-2061
Practice Address - Fax:718-479-7012
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine