Healthcare Provider Details

I. General information

NPI: 1043898786
Provider Name (Legal Business Name): KHODAYAR GOSHTASBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 60TH ST RM 908
NEW YORK NY
10022-1730
US

IV. Provider business mailing address

1 BROOKDALE PLZ
BROOKLYN NY
11212-3139
US

V. Phone/Fax

Practice location:
  • Phone: 212-223-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number341824
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: