Healthcare Provider Details

I. General information

NPI: 1083672133
Provider Name (Legal Business Name): TOORAJ ZAHEDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 AUSTIN ST SUITE 202
FOREST HILLS NY
11375-4242
US

IV. Provider business mailing address

PO BOX 920
ALPINE NJ
07620-0920
US

V. Phone/Fax

Practice location:
  • Phone: 718-575-9734
  • Fax: 718-575-5095
Mailing address:
  • Phone:
  • Fax: 201-784-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA50277
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA04949500
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number172612
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: