1588659627 NPI number — MELODI BUKET PIRZADA MD

Table of content: MELODI BUKET PIRZADA MD (NPI 1588659627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588659627 NPI number — MELODI BUKET PIRZADA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIRZADA
Provider First Name:
MELODI
Provider Middle Name:
BUKET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KARAKURUM
Provider Other First Name:
MELODI
Provider Other Middle Name:
BUKET
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588659627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 STATION PLZ N
Provider Second Line Business Mailing Address:
SUITE 611
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-3808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-663-2532
Provider Business Mailing Address Fax Number:
516-663-2233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 MINEOLA BLVD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
MINEOLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11501-4073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-663-4600
Provider Business Practice Location Address Fax Number:
516-663-3826
Provider Enumeration Date:
09/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0214X , with the licence number:  186356 , 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)

  • Identifier: 01551197 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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