Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 293068 | NY |
Y | 2084V0102X | Vascular Neurology | 293068 | NY |
NPI | 1073956264 |
---|---|
Provider Name | Dr. Shahram Majidi |
First Address | New York, NY 10029-6574 |
Second Address | New York, NY 10029-6508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2013 |
Last Update Date | 24/04/2020 |