Derisavifard, Samir

Derisavifard, Samir is an individual health care provider with primary practice located at 9225 Queens Blvd Fl 2 , Rego Park NY 11374. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Urology, Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery. Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery is his primary health care specialty. Derisavifard, Samir can be contacted via phone (817) 925-6200.

Contact Information

Primary practice address
9225 Queens Blvd Fl 2 Rego Park NY 11374
Phone: (817) 925-6200
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X S5157 Texas
Allopathic & Osteopathic Physicians / Urology 208800000X 282292-01 New York
Allopathic & Osteopathic Physicians / Female Pelvic Medicine and Reconstructive Surgery 2088F0040X 282292-01 New York

Profile Details

NPI number 1477997690
LBN Legal business name Derisavifard, Samir
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 18th, 2013
Last updated Jun 12th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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