Provider Demographics
NPI:1518937622
Name:KHAIRKHAH, NAZANINE (MD)
Entity Type:Individual
Prefix:DR
First Name:NAZANINE
Middle Name:
Last Name:KHAIRKHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 LAKE AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4501
Mailing Address - Country:US
Mailing Address - Phone:203-869-2304
Mailing Address - Fax:203-869-2304
Practice Address - Street 1:49 LAKE AVE STE 1B
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4501
Practice Address - Country:US
Practice Address - Phone:203-869-2304
Practice Address - Fax:203-869-2304
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232715207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02575919Medicaid
NY02575919Medicaid
I20445Medicare UPIN