Healthcare Provider Details

I. General information

NPI: 1609801612
Provider Name (Legal Business Name): HAIDEH HIRMAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 PARK AVENUE SUITE 1D-1E
NEW YORK NY
10028
US

IV. Provider business mailing address

1040 PARK AVENUE SUITE 1D-1E
NEW YORK NY
10028
US

V. Phone/Fax

Practice location:
  • Phone: 212-744-4400
  • Fax: 212-535-4644
Mailing address:
  • Phone: 212-744-4400
  • Fax: 212-535-4644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number197465
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number197465
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: