Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N005601 | NY |
NPI | 1013955061 |
---|---|
Provider Name | Dr. Behrooz Mandanipour |
First Address | Brooklyn, NY 11234-2704 |
Second Address | Brooklyn, NY 11234-2704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 02/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02369946 | (05) | NY |
A300041434 | PTAN# (01) | |
U95765 | (02) | NY |