Provider Demographics
NPI:1083624001
Name:GHIASIAN, VAHID (MD)
Entity Type:Individual
Prefix:
First Name:VAHID
Middle Name:
Last Name:GHIASIAN
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 1:501 SEAVIEW AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3400
Mailing Address - Country:US
Mailing Address - Phone:718-683-3766
Mailing Address - Fax:718-683-3765
Practice Address - Street 1:501 SEAVIEW AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3400
Practice Address - Country:US
Practice Address - Phone:718-683-3766
Practice Address - Fax:718-683-3765
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0010082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H03526Medicare UPIN
598302Medicare ID - Type Unspecified