Provider Demographics
NPI:1609107796
Name:REZA ZARNEGAR, DO., PC
Entity Type:Organization
Organization Name:REZA ZARNEGAR, DO., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CLO
Authorized Official - Middle Name:
Authorized Official - Last Name:VEZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-886-1631
Mailing Address - Street 1:5916 174TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1539
Mailing Address - Country:US
Mailing Address - Phone:718-670-1512
Mailing Address - Fax:
Practice Address - Street 1:5916 174TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-1539
Practice Address - Country:US
Practice Address - Phone:718-670-1512
Practice Address - Fax:718-747-1262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2397362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty