Provider Demographics
NPI:1477516862
Name:BARZIDEH, OMID S (MD)
Entity Type:Individual
Prefix:
First Name:OMID
Middle Name:S
Last Name:BARZIDEH
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 1:1300 FRANKLIN AVE
Mailing Address - Street 2:SUITE UL3A
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1760
Mailing Address - Country:US
Mailing Address - Phone:516-747-8900
Mailing Address - Fax:516-663-3015
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:SUITE UL3A
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1886
Practice Address - Country:US
Practice Address - Phone:516-747-8900
Practice Address - Fax:516-663-3015
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY223614207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY559F31Medicare ID - Type Unspecified
NY1477516862Medicare NSC
H99862Medicare UPIN