Healthcare Provider Details

I. General information

NPI: 1518087030
Provider Name (Legal Business Name): LOHRASB AHMADIAN MD MPH MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 WEST 26TH STREET
NEW YORK NY
10001
US

IV. Provider business mailing address

PO BOX 3353
NEW YORK NY
10163-3353
US

V. Phone/Fax

Practice location:
  • Phone: 212-812-3579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number253603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: