MEDICARE: MANIJEH MOHAMMADIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0019X	Physical Rehabilitation Occupational Therapist	011768	NY

General Provider Information

NPI Number	:	1144180720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANIJEH MOHAMMADIAN

Provider Business Mailing Address
First Line	:	804 MIDDLE NECK RD APT 3F
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1911
Country	:	US
Telephone Number	:	646-730-8883
Fax Number	:

Provider Business Practice Location Address
First Line	:	804 MIDDLE NECK RD APT 3F
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11024-1911
Country	:	US
Telephone Number	:	646-730-8883
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2025
Last Update Date	:	11/14/2025

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