Healthcare Provider Details

I. General information

NPI: 1386135036
Provider Name (Legal Business Name): JONATHAN SOLAIMANZADEH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

501 S BROADWAY STE 102
HICKSVILLE NY
11801-5067
US

V. Phone/Fax

Practice location:
  • Phone: 877-768-8462
  • Fax:
Mailing address:
  • Phone: 516-513-1256
  • Fax: 516-513-1257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number319514
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number319514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: