Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Samir Derisavifard, MD

Individual provider Urology Physician · NPI 1477997690

Samir Derisavifard, MD is an Urology in Rego Park, New York. Qualified in 2013, 13 years ago. Practices with North Shore Lij Medical Group at North Nassau, PC, a 35-clinician group, accepts Medicare assignment and offers telehealth. Licensed in New York and Texas.

Years since qualifying
13
Licensed in
NY, TX
In the registry since
2013
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

9225 Queens Blvd Fl 2
Rego Park, NY 11374
Phone: (817) 925-6200
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician (primary) Taxonomy 2088F0040X · Licence 282292-01 (NY)
Urology Physician Taxonomy 208800000X · Licence S5157 (TX)
Urology Physician Taxonomy 208800000X · Licence 282292-01 (NY)

Record details

NPI number1477997690
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 18, 2013
Last updated in NPPESJune 12, 2024
Certification dateJune 12, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyUROLOGY
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice North Shore Lij Medical Group At North Nassau, Pc — 35 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Rego Park