1588730014 NPI number — DR. HESKELL KHOZOURI ZADEH

Table of content: DR. HESKELL KHOZOURI ZADEH (NPI 1588730014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588730014 NPI number — DR. HESKELL KHOZOURI ZADEH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHOZOURI ZADEH
Provider First Name:
HESKELL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1588730014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 HEMPSTEAD TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMINGDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11735-2518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-755-5855
Provider Business Mailing Address Fax Number:
516-755-0330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 HEMPSTEAD TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11735-2518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-755-5855
Provider Business Practice Location Address Fax Number:
516-755-0330
Provider Enumeration Date:
11/27/2006

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: 111N00000X , with the licence number:  X010623 , 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: 2119155 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3003959 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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