Provider Demographics
NPI:1215995139
Name:ALYESHMERNI, BAHRAM (MD)
Entity type:Individual
Prefix:
First Name:BAHRAM
Middle Name:
Last Name:ALYESHMERNI
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 1:26 PINE DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-829-0081
Mailing Address - Fax:516-487-6463
Practice Address - Street 1:26 PINE DRIVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-829-0081
Practice Address - Fax:516-487-6463
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156486207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05D163Medicare PIN
NYA60142Medicare UPIN