Healthcare Provider Details

I. General information

NPI: 1205763554
Provider Name (Legal Business Name): YASAMIN DEHBOZORGI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 OCEAN PKWY
BROOKLYN NY
11235-7745
US

IV. Provider business mailing address

1411 AVENUE N APT B5
BROOKLYN NY
11230-5934
US

V. Phone/Fax

Practice location:
  • Phone: 718-616-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number996787
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: