Healthcare Provider Details

I. General information

NPI: 1447179049
Provider Name (Legal Business Name): PINHAS TAVAKOLY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MIDDLE NECK RD
GREAT NECK NY
11024-1932
US

IV. Provider business mailing address

801 MIDDLE NECK RD
GREAT NECK NY
11024-1932
US

V. Phone/Fax

Practice location:
  • Phone: 516-718-3120
  • Fax: 516-718-7120
Mailing address:
  • Phone: 516-718-3120
  • Fax: 516-718-7120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: