Healthcare Provider Details

I. General information

NPI: 1316799042
Provider Name (Legal Business Name): PY MEDICAL SERVICES OF MO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10954 KENNERLY RD
SAINT LOUIS MO
63128-2018
US

IV. Provider business mailing address

3438 BELL BLVD STE 301
BAYSIDE NY
11361-1739
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-4242
  • Fax:
Mailing address:
  • Phone: 718-709-0940
  • Fax: 516-441-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PEYMAN YOUNESI
Title or Position: OWNER
Credential: MD
Phone: 718-709-0940