Provider Demographics
NPI:1841231545
Name:NAGHAVI, REZA S (MD)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:S
Last Name:NAGHAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4704
Mailing Address - Country:US
Mailing Address - Phone:516-536-5765
Mailing Address - Fax:516-536-5766
Practice Address - Street 1:178 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4704
Practice Address - Country:US
Practice Address - Phone:516-536-5765
Practice Address - Fax:516-536-5766
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113465674OtherTAX ID
NY01801418Medicaid
NY113465674OtherTAX ID
NY01801418Medicaid