Healthcare Provider Details

I. General information

NPI: 1275730087
Provider Name (Legal Business Name): ROYA MUKHTARZAD D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 EAST 49TH STREET SUITE D
BROOKLYN NY
11203
US

IV. Provider business mailing address

339 E 57TH ST #4E
NEW YORK NY
10022-2909
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5000
  • Fax:
Mailing address:
  • Phone: 917-406-6377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number244767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: