Provider Demographics
NPI:1952626103
Name:ALIZADEH BAJGIRAN, AHMADREZA (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMADREZA
Middle Name:
Last Name:ALIZADEH BAJGIRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AHMADREZA
Other - Middle Name:
Other - Last Name:ALIZADEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100 EAST 77TH ST., 3RD FLOOR
Mailing Address - Street 2:ADVANCED IMAGING AND RADIOLOGY OF LENOX HILL HOSPITAL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075
Mailing Address - Country:US
Mailing Address - Phone:212-434-6912
Mailing Address - Fax:
Practice Address - Street 1:100 EAST 77TH ST., 3RD FLOOR
Practice Address - Street 2:ADVANCED IMAGING AND RADIOLOGY OF LENOX HILL HOSPITAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075
Practice Address - Country:US
Practice Address - Phone:212-434-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255387-1207R00000X
NY225387-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine