Healthcare Provider Details

I. General information

NPI: 1275861122
Provider Name (Legal Business Name): AZIN JANNATIFAR MIDWIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7606
US

IV. Provider business mailing address

64 KNOLLS DRIVE NORTH
MANHASSET NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-8383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number001174
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: