Provider Demographics
NPI:1588975304
Name:JAHANBAKHSH NASSERZARE MD, PA
Entity type:Organization
Organization Name:JAHANBAKHSH NASSERZARE MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAHANBAKHSH
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSERZARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-940-0064
Mailing Address - Street 1:1380 NE MIAMI GARDENS DR STE 140
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4744
Mailing Address - Country:US
Mailing Address - Phone:305-940-0064
Mailing Address - Fax:305-940-0066
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 140
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4744
Practice Address - Country:US
Practice Address - Phone:305-940-0064
Practice Address - Fax:305-940-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1026042084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002467900Medicaid
FL010587700Medicaid
FL010587700Medicaid
FL002467900Medicaid