Provider Demographics
NPI:1033366745
Name:NASSIRI, NAIEM (MD)
Entity Type:Individual
Prefix:DR
First Name:NAIEM
Middle Name:
Last Name:NASSIRI
Suffix:
Gender:M
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:YALE UNIVERSITY
Mailing Address - Street 2:330 CEDAR STREET, BOARDMAN BUILDING 204
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510
Mailing Address - Country:US
Mailing Address - Phone:818-388-8899
Mailing Address - Fax:
Practice Address - Street 1:YALE UNIVERSITY
Practice Address - Street 2:330 CEDAR STREET, BOARDMAN BUILDING 204
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:818-388-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA093080002086S0129X
390200000X
CT566962086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty