Provider Demographics
NPI:1790720027
Name:ASHOURZADEH, BITA (MD)
Entity Type:Individual
Prefix:
First Name:BITA
Middle Name:
Last Name:ASHOURZADEH
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 1:90 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11024-1223
Mailing Address - Country:US
Mailing Address - Phone:516-796-4433
Mailing Address - Fax:
Practice Address - Street 1:90 WILDWOOD RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11024-1223
Practice Address - Country:US
Practice Address - Phone:516-796-4433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02227989Medicaid
H65136Medicare UPIN
NY02227989Medicaid