Healthcare Provider Details

I. General information

NPI: 1083624001
Provider Name (Legal Business Name): VAHID GHIASIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEAVIEW AVE SUITE 104
STATEN ISLAND NY
10305-3400
US

IV. Provider business mailing address

501 SEAVIEW AVE SUITE 104
STATEN ISLAND NY
10305-3400
US

V. Phone/Fax

Practice location:
  • Phone: 718-683-3766
  • Fax: 718-683-3765
Mailing address:
  • Phone: 718-683-3766
  • Fax: 718-683-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number001008
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: