Healthcare Provider Details

I. General information

NPI: 1841010303
Provider Name (Legal Business Name): ALEX SHOKOUHI MOHSENI MEDICAL OF NEW YORK, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10811 BARN WOOD LN
POTOMAC MD
20854-1329
US

IV. Provider business mailing address

228 PARK AVE S # 42690
NEW YORK NY
10003-1502
US

V. Phone/Fax

Practice location:
  • Phone: 877-372-1104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEX MOHSENI
Title or Position: PRESIDENT
Credential: MD
Phone: 301-706-4461