Provider Demographics
NPI:1538192414
Name:HARDOON, MIRIAM (MD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:HARDOON
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 1:6715 102ND ST
Mailing Address - Street 2:1-U
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2453
Mailing Address - Country:US
Mailing Address - Phone:718-459-2952
Mailing Address - Fax:718-459-7971
Practice Address - Street 1:6715 102ND ST
Practice Address - Street 2:1-U
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2453
Practice Address - Country:US
Practice Address - Phone:718-459-2952
Practice Address - Fax:718-459-7971
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171227208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01210246Medicaid
NY00175Medicare ID - Type Unspecified
NY01210246Medicaid