Healthcare Provider Details

I. General information

NPI: 1639791155
Provider Name (Legal Business Name): AMIR REZA RADJABI MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
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

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

V. Phone/Fax

Practice location:
  • Phone: 212-535-5350
  • Fax:
Mailing address:
  • Phone: 800-750-8616
  • 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: AMIR REZA RADJABI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 917-444-5444