Healthcare Provider Details

I. General information

NPI: 1558208124
Provider Name (Legal Business Name): ALIREZA KARANDISH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALI KARANDISH

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

1935 EASTCHESTER RD APT 15E
BRONX NY
10461-2188
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4321
  • Fax:
Mailing address:
  • Phone: 310-956-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number390200000X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: