MEDICARE: HABIB NAZARIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	142782	NY
2	2080P0202X	Pediatric Cardiology Physician	142782	NY

General Provider Information

NPI Number	:	1114925336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HABIB NAZARIAN M.D.

Provider Business Mailing Address
First Line	:	8 PARK DR E
Second Line	:
City	:	OLD WESTBURY
State	:	NY
Zip	:	11568-1125
Country	:	US
Telephone Number	:	516-626-6222
Fax Number	:	718-712-5666

Provider Business Practice Location Address
First Line	:	23520 147TH AVE
Second Line	:
City	:	ROSEDALE
State	:	NY
Zip	:	11422-3293
Country	:	US
Telephone Number	:	718-712-2200
Fax Number	:	718-712-5666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/08/2011

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