Healthcare Provider Details

I. General information

NPI: 1699410696
Provider Name (Legal Business Name): SABA BAKHTIARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST
MOUNT KISCO NY
10549-3417
US

IV. Provider business mailing address

102 WATCH HILL DR
TARRYTOWN NY
10591-5053
US

V. Phone/Fax

Practice location:
  • Phone: 191-466-6120
  • Fax:
Mailing address:
  • Phone: 516-754-2804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34473
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT226983
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: