Provider Demographics
NPI:1457431751
Name:HONARVAR, ALIZA (MD)
Entity Type:Individual
Prefix:
First Name:ALIZA
Middle Name:
Last Name:HONARVAR
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-0010
Mailing Address - Country:US
Mailing Address - Phone:516-621-6655
Mailing Address - Fax:516-621-6660
Practice Address - Street 1:140 58TH ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2521
Practice Address - Country:US
Practice Address - Phone:718-492-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117516-1207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE07279Medicare UPIN