1982836334 NPI number — SHERRY SHAHRZAD NAZARIAN D.P.M. P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982836334 NPI number — SHERRY SHAHRZAD NAZARIAN D.P.M. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERRY SHAHRZAD NAZARIAN D.P.M. P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982836334
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2266 E 64TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11234-6314
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-444-8151
Provider Business Mailing Address Fax Number:
718-363-6647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2083 E 53RD PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234-4710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-258-2500
Provider Business Practice Location Address Fax Number:
718-865-5112
Provider Enumeration Date:
08/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NAZARIAN
Authorized Official First Name:
SHAHRZAD
Authorized Official Middle Name:
SHERRY
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
718-207-8256

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  N005761 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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