Provider Demographics
NPI:1063408474
Name:AIVAZI, ZAZA J (MD)
Entity type:Individual
Prefix:
First Name:ZAZA
Middle Name:J
Last Name:AIVAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 45TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1621
Mailing Address - Country:US
Mailing Address - Phone:718-721-1500
Mailing Address - Fax:718-777-1623
Practice Address - Street 1:150 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1922
Practice Address - Country:US
Practice Address - Phone:212-439-6000
Practice Address - Fax:212-439-1526
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22374207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02491454Medicaid
NY000SR1Medicare PIN
NYI02188Medicare UPIN
NY4989GKMedicare PIN