Healthcare Provider Details

I. General information

NPI: 1215981824
Provider Name (Legal Business Name): NAZANIN BARZIDEH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 OLD COUNTRY RD STE 301
CARLE PLACE NY
11514-2131
US

IV. Provider business mailing address

393 OLD COUNTRY RD STE 301
CARLE PLACE NY
11514-2131
US

V. Phone/Fax

Practice location:
  • Phone: 516-408-4902
  • Fax: 516-408-4911
Mailing address:
  • Phone: 516-408-4900
  • Fax: 516-408-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number226005
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number226005
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: