Healthcare Provider Details

I. General information

NPI: 1669769428
Provider Name (Legal Business Name): GOLALEH BARZANI DMD FACS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 05/30/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 SARATOGA RD # 1
SCHENECTADY NY
12302-4513
US

IV. Provider business mailing address

4 PALISADES DR STE 250
ALBANY NY
12205-1448
US

V. Phone/Fax

Practice location:
  • Phone: 518-240-3750
  • Fax:
Mailing address:
  • Phone: 518-240-3750
  • Fax: 518-240-3759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number057247-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: