Healthcare Provider Details

I. General information

NPI: 1396656039
Provider Name (Legal Business Name): DR. SEJAD AHMADZADA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

504 E 63RD ST APT 33L
NEW YORK NY
10065-7929
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-2996
  • Fax:
Mailing address:
  • Phone: 212-639-2996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberP143450
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: