Healthcare Provider Details

I. General information

NPI: 1538817671
Provider Name (Legal Business Name): JONATHAN PARSA OHADI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FLATBUSH AVENUE EXT
BROOKLYN NY
11201-2903
US

IV. Provider business mailing address

40 FLATBUSH AVENUE EXT
BROOKLYN NY
11201-2903
US

V. Phone/Fax

Practice location:
  • Phone: 646-965-5540
  • Fax:
Mailing address:
  • Phone: 646-965-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114969-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: