Provider Demographics
NPI:1073769154
Name:SHIRVANI, ALIREZA (MD)
Entity type:Individual
Prefix:DR
First Name:ALIREZA
Middle Name:
Last Name:SHIRVANI
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 1:33 HOFSTRA DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1814
Mailing Address - Country:US
Mailing Address - Phone:516-418-7942
Mailing Address - Fax:516-407-5498
Practice Address - Street 1:287 NORTHERN BLVD STE 108
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4717
Practice Address - Country:US
Practice Address - Phone:516-418-6942
Practice Address - Fax:516-407-5498
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270376207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03716676Medicaid
PA102502514Medicaid