Provider Demographics
NPI:1982884276
Name:NAFISI, NIRA SURI (PHD)
Entity Type:Individual
Prefix:DR
First Name:NIRA
Middle Name:SURI
Last Name:NAFISI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:NIRA
Other - Middle Name:SURI
Other - Last Name:GOLOMBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:29 BARSTOW RD STE 102
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2209
Mailing Address - Country:US
Mailing Address - Phone:516-297-9810
Mailing Address - Fax:
Practice Address - Street 1:29 BARSTOW RD STE 102
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2209
Practice Address - Country:US
Practice Address - Phone:516-297-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017337-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical