Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Misagh Fasazadeh

Individual provider Physician Assistant · NPI 1376177428

Misagh Fasazadeh is a Physician Assistant in Great Neck, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2020

Practice location Address checks out

140 S Middle Neck Rd Apt 2E
Great Neck, NY 11021-3738
Phone: (818) 642-4131
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 025221 (NY)

Record details

NPI number1376177428
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedFebruary 27, 2020
Last updated in NPPESJuly 13, 2020
Certification dateJuly 13, 2020
Mailing address140 S Middle Neck Rd Apt 2e, Great Neck, NY 11021-3738

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