Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101248524 | VA |
Y | 207QA0505X | Family Doctor - Adult Medicine | 261697 | NY |
N | 207QA0505X | Family Doctor - Adult Medicine | C168003 | CA |
NPI | 1235465089 |
---|---|
Provider Name | Reza Mesbah |
First Address | Jackson Heights, NY 11372-7001 |
Second Address | Jackson Heights, NY 11372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2009 |
Last Update Date | 27/12/2021 |