Provider Demographics
NPI:1053571430
Name:NABIZADEH, FARZANEH A (MD)
Entity type:Individual
Prefix:
First Name:FARZANEH
Middle Name:A
Last Name:NABIZADEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:646-962-3020
Mailing Address - Fax:646-962-0088
Practice Address - Street 1:232 WEST 80TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:646-962-3020
Practice Address - Fax:646-962-0088
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA235371207V00000X
NY279975207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2161061Medicaid
MA2161061Medicaid