Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 017728 | CT |
NPI | 1023045408 |
---|---|
Provider Name | Iraj Cyrus Rahmati |
First Address | New Milford, CT 06776-2530 |
Second Address | New Milford, CT 06776-2530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 22/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B37669 | (02) |