Healthcare Provider Details

I. General information

NPI: 1396014940
Provider Name (Legal Business Name): CYRUS A ASSADI MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CENTRAL PARK WEST SUITE 1M
NEW YORK NY
10023-7205
US

IV. Provider business mailing address

25 CENTRAL PARK WEST SUITE 1M
NEW YORK NY
10023-7205
US

V. Phone/Fax

Practice location:
  • Phone: 212-315-3322
  • Fax: 718-872-6108
Mailing address:
  • Phone: 212-315-3322
  • Fax: 718-872-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number139823
License Number StateNY

VIII. Authorized Official

Name: CYRUS A ASSADI
Title or Position: PRESIDENT
Credential: MD
Phone: 718-809-6973