Healthcare Provider Details

I. General information

NPI: 1770074981
Provider Name (Legal Business Name): JASON NAZIRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 EASTCHESTER RD
BRONX NY
10469-5930
US

IV. Provider business mailing address

1 RESEARCH RD
RIDGE NY
11961-2701
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-0400
  • Fax:
Mailing address:
  • Phone: 631-751-3000
  • Fax: 631-751-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number321967
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: