Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 117865 | NY |
NPI | 1013083419 |
---|---|
Provider Name | Farrokh Shahrivar |
First Address | New York, NY 10021-0732 |
Second Address | New York, NY 10025-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B80293 | (02) | NY |