Healthcare Provider Details

I. General information

NPI: 1770604571
Provider Name (Legal Business Name): WOODLAWN MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 EAST 205TH STREET FLOOR C
BRONX NY
10458-1202
US

IV. Provider business mailing address

174 EAST 205TH STREET FLOOR C
BRONX NY
10458-1202
US

V. Phone/Fax

Practice location:
  • Phone: 718-562-2200
  • Fax: 718-562-2194
Mailing address:
  • Phone: 718-562-2200
  • Fax: 718-562-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PARISA TAFRESHI-ORAEE
Title or Position: OWNER
Credential: MD
Phone: 718-562-2200