# PRR DIAGNOSTIC MEDICINE PC

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

## Provider details

- **NPI number:** 1780086363
- **Authorized official:** MUHAMMAD MIRZA MD (DIRECTOR)
- **Authorized official phone:** (973) 493-7607

## Contact information

- **Practice address:** 1265 CLOVE RD, STATEN ISLAND, NY 10301-4339
- **Practice address phone:** (973) 493-7607
- **Practice address fax:** (914) 470-5056
- **Mailing address:** 1265 CLOVE RD, STATEN ISLAND, NY 10301-4339
- **Mailing address phone:** (973) 493-7607
- **Mailing address fax:** (914) 470-5056

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NY | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |

## Other

- **Enumeration date:** 09/25/2014
- **Last updated:** 09/25/2014