Provider Demographics
NPI:1427042654
Name:SASSON, HOMAYOUN N (MD)
Entity Type:Individual
Prefix:
First Name:HOMAYOUN
Middle Name:N
Last Name:SASSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 NORTHERN BLVD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5312
Mailing Address - Country:US
Mailing Address - Phone:516-487-5017
Mailing Address - Fax:516-487-2839
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:SUITE 370
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5312
Practice Address - Country:US
Practice Address - Phone:516-487-5017
Practice Address - Fax:516-487-2839
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY202669208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03237OtherGHI MEDICARE
NY467971OtherBCBS MEDICARE
NY03237OtherGHI MEDICARE