Healthcare Provider Details

I. General information

NPI: 1356862221
Provider Name (Legal Business Name): RADJABI MEDICAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CENTRAL PARK S APT 1P
NEW YORK NY
10019-1429
US

IV. Provider business mailing address

26 FIREMENS MEMORIAL DR STE 115
POMONA NY
10970-3569
US

V. Phone/Fax

Practice location:
  • Phone: 212-535-5350
  • Fax: 212-535-5080
Mailing address:
  • Phone: 845-362-8400
  • Fax: 845-362-8474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMIR REZA RADJABI RAHAT
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 845-362-8400