Provider Demographics
NPI:1972531010
Name:NEZIROGLU, FUGEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:FUGEN
Middle Name:
Last Name:NEZIROGLU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 NORTHERN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5309
Mailing Address - Country:US
Mailing Address - Phone:516-487-7116
Mailing Address - Fax:516-829-1731
Practice Address - Street 1:935 NORTHERN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5309
Practice Address - Country:US
Practice Address - Phone:516-487-7116
Practice Address - Fax:516-829-1731
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06151103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFN0V146710Medicare ID - Type Unspecified