Provider Demographics
NPI:1306297254
Name:NASIRI, AZADEH (MD)
Entity type:Individual
Prefix:
First Name:AZADEH
Middle Name:
Last Name:NASIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AZADEH
Other - Middle Name:
Other - Last Name:NASIRI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2 HILLSIDE AVE STE G
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2335
Mailing Address - Country:US
Mailing Address - Phone:516-280-3980
Mailing Address - Fax:718-380-3736
Practice Address - Street 1:2 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2392
Practice Address - Country:US
Practice Address - Phone:516-280-3980
Practice Address - Fax:718-380-3736
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302269207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics