Provider Demographics
NPI:1942386735
Name:NISANIAN, ANAHID J (MD)
Entity Type:Individual
Prefix:MS
First Name:ANAHID
Middle Name:J
Last Name:NISANIAN
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 1:381 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2806
Mailing Address - Country:US
Mailing Address - Phone:718-802-1110
Mailing Address - Fax:718-802-1113
Practice Address - Street 1:332 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3820
Practice Address - Country:US
Practice Address - Phone:718-852-5252
Practice Address - Fax:718-802-1113
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02605127Medicaid
NY02605127Medicaid
NYWET021Medicare PIN
NYI19408Medicare UPIN