Healthcare Provider Details

I. General information

NPI: 1316854854
Provider Name (Legal Business Name): SAYED-MOHAMMAD BANITABAEI-KOUPAEI D.C., M.ENG.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 W 10TH ST
BROOKLYN NY
11223-1104
US

IV. Provider business mailing address

1150 MOUNT HOPE AVE APT 6
ROCHESTER NY
14620-2944
US

V. Phone/Fax

Practice location:
  • Phone: 585-362-9598
  • Fax:
Mailing address:
  • Phone: 585-362-9598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number014082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: