Individual
DR. SAMUEL BAHARESTANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
260 E MIDDLE COUNTRY RD, SUITE 201, SMITHTOWN, NY 11787-2982
(631) 265-8780
(631) 265-8521
Mailing address
260 E MIDDLE COUNTRY RD, SUITE 201, SMITHTOWN, NY 11787-2982
(631) 265-8780
(631) 265-8521
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
252341
NY
207W00000X
Ophthalmology Physician
35.098787
OH
207W00000X
Ophthalmology Physician
45126
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000759307
BCBS
OH
05
—
201065620
—
IN
Enumeration date
05/05/2008
Last updated
07/17/2014
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