Basic Information
| Provider Information | |||||||||
| NPI: | 1841231545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGHAVI | ||||||||
| FirstName: | REZA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 178 SUNRISE HWY | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115704704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165365765 | ||||||||
| FaxNumber: | 5165365766 | ||||||||
| Practice Location | |||||||||
| Address1: | 178 SUNRISE HWY | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115704704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165365765 | ||||||||
| FaxNumber: | 5165365766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 04/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 207203 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 113465674 | 01 | NY | TAX ID | OTHER | 01801418 | 05 | NY | MEDICAID |