Healthcare Provider Details

I. General information

NPI: 1659350684
Provider Name (Legal Business Name): MEHDI MOHAMMED OLOOMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MOHAMMAD MEDHI OLOOMI-YAZDI M.D.

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 5TH AVE BOX 1028
NEW YORK NY
10029-6503
US

IV. Provider business mailing address

1190 5TH AVE BOX1028
NEW YORK NY
10029-6503
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-6800
  • Fax: 212-659-6818
Mailing address:
  • Phone: 212-659-6800
  • Fax: 212-659-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number224647
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number224647
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number224647
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number224647
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: