Healthcare Provider Details

I. General information

NPI: 1851928220
Provider Name (Legal Business Name): AMIR MICHAEL RAZANI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E 67TH ST
NEW YORK NY
10065-6136
US

IV. Provider business mailing address

130 E 67TH ST
NEW YORK NY
10065-6136
US

V. Phone/Fax

Practice location:
  • Phone: 212-392-6547
  • Fax:
Mailing address:
  • Phone: 212-392-6547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number328693
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: