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General NPI Number Information
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NPI Number | 1548566342
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Entity Type | Organization
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Legal Business Name | NORTH SHORE RETINA PHYSICIAN, PLLC
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 300 OLD COUNTRY RD SUITE GL 51
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City | MINEOLA
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State | NY
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Zip | 11501-4198
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Country | US
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Telephone | 516-729-8515
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Fax | 516-277-1528
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Provider Business Mailing Address
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Address Line | 74 FINCH DR
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City | ROSLYN
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State | NY
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Zip | 11576-2705
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Country | US
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Telephone | 516-729-8515
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Fax | 516-277-1528
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MRS. NAZANIN BARZIDEH
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Credential | MD
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Telephone | 516-729-8515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 226005
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License Number State | NY
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