Provider Demographics
NPI:1811937204
Name:ZANDI, TAHER (PHD)
Entity type:Individual
Prefix:
First Name:TAHER
Middle Name:
Last Name:ZANDI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W BAY PLZ
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1785
Mailing Address - Country:US
Mailing Address - Phone:518-561-3707
Mailing Address - Fax:518-825-3707
Practice Address - Street 1:110 W BAY PLZ
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1785
Practice Address - Country:US
Practice Address - Phone:518-561-3707
Practice Address - Fax:518-825-3707
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015955103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02703542Medicaid
NYRA4182Medicare ID - Type Unspecified