Provider Demographics
NPI:1912969197
Name:BARZEGAR, HOOSHANG (MD)
Entity type:Individual
Prefix:
First Name:HOOSHANG
Middle Name:
Last Name:BARZEGAR
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 1:1636 E 14TH ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1100
Mailing Address - Country:US
Mailing Address - Phone:718-998-3500
Mailing Address - Fax:718-998-1063
Practice Address - Street 1:1636 E 14TH ST
Practice Address - Street 2:SUITE 124
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1100
Practice Address - Country:US
Practice Address - Phone:718-998-3500
Practice Address - Fax:718-998-1063
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY107034-1207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY659831OtherEMPIRE BLUE CROSS
NYB78785Medicare UPIN
NY659831OtherEMPIRE BLUE CROSS