Provider Demographics
NPI:1750718607
Name:IRENE ZIDE MD
Entity type:Organization
Organization Name:IRENE ZIDE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-371-0517
Mailing Address - Street 1:290 CENTRAL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-8507
Mailing Address - Country:US
Mailing Address - Phone:516-371-0517
Mailing Address - Fax:516-371-0519
Practice Address - Street 1:290 CENTRAL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-8507
Practice Address - Country:US
Practice Address - Phone:516-371-0517
Practice Address - Fax:516-371-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151719207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty