Provider Demographics
NPI:1548566342
Name:NORTH SHORE RETINA PHYSICIAN, PLLC
Entity Type:Organization
Organization Name:NORTH SHORE RETINA PHYSICIAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAZANIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARZIDEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-729-8515
Mailing Address - Street 1:74 FINCH DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2705
Mailing Address - Country:US
Mailing Address - Phone:516-729-8515
Mailing Address - Fax:516-277-1528
Practice Address - Street 1:300 OLD COUNTRY RD
Practice Address - Street 2:SUITE GL 51
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4198
Practice Address - Country:US
Practice Address - Phone:516-729-8515
Practice Address - Fax:516-277-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226005207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133770Medicare UPIN