Healthcare Provider Details

I. General information

NPI: 1255481586
Provider Name (Legal Business Name): PARVANEH GOLBARI MS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 E 142ND ST SEGUNDO RUIZ BELVIS D&TC
BRONX NY
10454-2110
US

IV. Provider business mailing address

47 STEPPING STONE LN
GREAT NECK NY
11024-1313
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-1710
  • Fax: 718-579-1740
Mailing address:
  • Phone: 718-579-1710
  • Fax: 718-579-1740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number943609
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: