# METHODIST OUTRACH LAB

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205912813
- **Authorized official:** RABIA MIR MD (DIRECTOR)
- **Authorized official phone:** (718) 780-3016

## Contact information

- **Practice address:** 506 6TH ST, BROOKLYN, NY 11215-3609
- **Practice address phone:** (718) 780-3016
- **Mailing address:** 1900 HEMPSTEAD TPKE, SUITE 500, EAST MEADOW, NY 11554-1724
- **Mailing address phone:** (516) 542-1090
- **Mailing address fax:** (516) 794-8165

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207NI0002X | Clinical & Laboratory Dermatological Immunology Physician | — | NULL | Yes |
| 207NI0002X | Clinical & Laboratory Dermatological Immunology Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/27/2006
- **Last updated:** 08/22/2020