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General NPI Number Information
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NPI Number | 1255533147
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Entity Type | Individual
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Provider Name | NAZANIN GANJIAN
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Gender | Female
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Dates
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Enumeration Date | 06/03/2007
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Last Update Date | 02/02/2017
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Provider Practice Location Address
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Address Line | 179 ATLANTIC AVE
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City | FREEPORT
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State | NY
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Zip | 11520-4922
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Country | US
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Telephone | 516-377-4050
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Fax |
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Provider Business Mailing Address
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Address Line | 125 HARBOR LN
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City | ROSLYN
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State | NY
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Zip | 11576-1151
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Country | US
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Telephone | 516-671-8206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 049252
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License Number State | NY
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