Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 302269 | NY |
NPI | 1306297254 |
---|---|
Provider Name | Azadeh Nasiri |
First Address | Williston Park, NY 11596-2335 |
Second Address | Williston Park, NY 11596-2392 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 21/07/2021 |