Provider Demographics
NPI:1215981824
Name:BARZIDEH, NAZANIN (MD)
Entity type:Individual
Prefix:DR
First Name:NAZANIN
Middle Name:
Last Name:BARZIDEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 OLD COUNTRY RD STE 301
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-2131
Mailing Address - Country:US
Mailing Address - Phone:516-408-4900
Mailing Address - Fax:516-408-4911
Practice Address - Street 1:200 OLD COUNTRY RD
Practice Address - Street 2:SUITE 130
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4235
Practice Address - Country:US
Practice Address - Phone:516-408-4902
Practice Address - Fax:516-408-4911
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226005207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001451682Medicaid
CTP00401705Medicare PIN
CT001451682Medicaid
NY133770Medicare UPIN
I33770Medicare UPIN