=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841675287
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEZHAT SURGERY FOR GYNECOLOGY/ONCOLOGY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2015
-----------------------------------------------------
Last Update Date | 04/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 E SUNRISE HWY STE 515W
-----------------------------------------------------
City | VALLEY STREAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11581-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-663-1365
-----------------------------------------------------
Fax | 516-710-7685
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 70 E SUNRISE HWY STE 515W
-----------------------------------------------------
City | VALLEY STREAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11581-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-663-1365
-----------------------------------------------------
Fax | 516-710-7685
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | FARR R. NEZHAT, MD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 516-663-1365
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VX0201X
-----------------------------------------------------
Taxonomy Name | Gynecologic Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------