MEDICARE: BITA ASHOURZADEH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	221358	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790720027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BITA ASHOURZADEH MD

Provider Business Mailing Address
First Line	:	90 WILDWOOD RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1223
Country	:	US
Telephone Number	:	516-610-5081
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 WILDWOOD RD
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1223
Country	:	US
Telephone Number	:	516-796-4433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	06/14/2024

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