Healthcare Provider Details

I. General information

NPI: 1649926072
Provider Name (Legal Business Name): PANIEH TERRAF PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 1ST AVE BLDG S-730A
NEW YORK NY
10065-6038
US

IV. Provider business mailing address

1250 1ST AVE BLDG S-730A
NEW YORK NY
10065-6038
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-5170
  • Fax:
Mailing address:
  • Phone: 212-639-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License Number2021217
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number2021217
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: