Provider Demographics
NPI:1619153772
Name:ZANDIEH, PEYMAN S (MD, PC)
Entity Type:Individual
Prefix:
First Name:PEYMAN
Middle Name:S
Last Name:ZANDIEH
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 HEMPSTEAD TPKE
Mailing Address - Street 2:STE 208
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5700
Mailing Address - Country:US
Mailing Address - Phone:516-735-7900
Mailing Address - Fax:516-735-8425
Practice Address - Street 1:4230 HEMPSTEAD TPKE
Practice Address - Street 2:STE 208
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5700
Practice Address - Country:US
Practice Address - Phone:516-735-7900
Practice Address - Fax:516-735-8425
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY198779207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG48977Medicare UPIN
NY472C31Medicare PIN