Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 275768-1 | NY |
N | 208800000X | Urologist | MD444707 | PA |
NPI | 1003014267 |
---|---|
Provider Name | Dr. Reza Mehrazin |
First Address | New York, NY 10029-6504 |
Second Address | New York, NY 10029-6504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 16/01/2015 |