Provider Demographics
NPI:1114925336
Name:NAZARIAN, HABIB (MD)
Entity Type:Individual
Prefix:
First Name:HABIB
Middle Name:
Last Name:NAZARIAN
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 1:8 PARK DR E
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1125
Mailing Address - Country:US
Mailing Address - Phone:516-626-6222
Mailing Address - Fax:718-712-5666
Practice Address - Street 1:23520 147TH AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3293
Practice Address - Country:US
Practice Address - Phone:718-712-2200
Practice Address - Fax:718-712-5666
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142782208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE37770Medicare UPIN