Basic Information
Provider Information
NPI: 1265883920
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NAKAZI
FirstName: SAIDE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1001 W FAYETTE ST STE 400
Address2:  
City: SYRACUSE
State: NY
PostalCode: 132042866
CountryCode: US
TelephoneNumber: 3159373433
FaxNumber:  
Practice Location
Address1: 739 IRVING AVE STE 200
Address2:  
City: SYRACUSE
State: NY
PostalCode: 132101668
CountryCode: US
TelephoneNumber: 3154795070
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/23/2016
LastUpdateDate: 09/01/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X310841NYY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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