Provider Demographics
NPI:1952462483
Name:KAZEMI, PARVIZ
Entity Type:Individual
Prefix:DR
First Name:PARVIZ
Middle Name:
Last Name:KAZEMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 E MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2915
Mailing Address - Country:US
Mailing Address - Phone:631-292-2459
Mailing Address - Fax:631-663-3141
Practice Address - Street 1:278 E MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2915
Practice Address - Country:US
Practice Address - Phone:631-292-2459
Practice Address - Fax:631-663-3141
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1162192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
P518611OtherOXFORD
NYP600215169Medicaid
NYP600215169Medicaid
NY953821Medicare PIN