Healthcare Provider Details

I. General information

NPI: 1366948978
Provider Name (Legal Business Name): AZADEH BEHESHTIAN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARK AVE
NEW YORK NY
10016-4348
US

IV. Provider business mailing address

15 PARK AVE
NEW YORK NY
10016-4348
US

V. Phone/Fax

Practice location:
  • Phone: 347-695-4225
  • Fax: 833-224-5817
Mailing address:
  • Phone: 347-695-4225
  • Fax: 833-224-5817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AZADEH BEHESHTIAN
Title or Position: OWNER
Credential: MD
Phone: 415-999-3090