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NPI Code Detail

MEDICARE: GENEVA TAVAKOLI

MEDICARE: GENEVA TAVAKOLI
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
1101Y00000XCounselor097086-1NY

General Provider Information

NPI Number : 1609230416
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENEVA TAVAKOLI
Provider Business Mailing Address
First Line : 435 E 119TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10035-3627
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 435 E 119TH ST
Second Line :
City : NEW YORK
State : NY
Zip : 10035-3627
Country : US
Telephone Number : 212-360-4002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2016
Last Update Date : 04/07/2016

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Directions to “ GENEVA TAVAKOLI ” Practice Location

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