Provider Demographics
NPI:1518207257
Name:NASSIRZADEH, DANIEL (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:NASSIRZADEH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WINSTON DR
Mailing Address - Street 2:APT. 1119
Mailing Address - City:CLIFFSIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-3235
Mailing Address - Country:US
Mailing Address - Phone:646-732-4891
Mailing Address - Fax:201-594-9778
Practice Address - Street 1:200 WINSTON DR
Practice Address - Street 2:APT. 1119
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3235
Practice Address - Country:US
Practice Address - Phone:646-732-4891
Practice Address - Fax:201-594-9778
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-17
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012234-1111N00000X
NJ38MC00703000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor