Individual
SAMIR DERISAVIFARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9225 QUEENS BLVD FL 2, REGO PARK, NY 11374
(817) 925-6200
Mailing address
9225 QUEENS BLVD FL 2, REGO PARK, NY 11374
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
282292-01
NY
208800000X
Urology Physician
S5157
TX
2088F0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
Primary
282292-01
NY
Other
Enumeration date
04/18/2013
Last updated
06/12/2024
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