Healthcare Provider Details

I. General information

NPI: 1922395128
Provider Name (Legal Business Name): MAHBOUBEH ZAFARMEHR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1624 E 14TH ST
BROOKLYN NY
11229-1104
US

IV. Provider business mailing address

1624 EAST 14TH STREET
BROOKLYN NY
11229
US

V. Phone/Fax

Practice location:
  • Phone: 718-376-2220
  • Fax: 718-376-2226
Mailing address:
  • Phone: 718-376-2220
  • Fax: 718-376-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009447
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: