Healthcare Provider Details

I. General information

NPI: 1841452851
Provider Name (Legal Business Name): MAHSA MEHRAZIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E 55TH ST FL 3
NEW YORK NY
10022-3205
US

IV. Provider business mailing address

55 E 55TH ST FL 3
NEW YORK NY
10022-3205
US

V. Phone/Fax

Practice location:
  • Phone: 646-754-2000
  • Fax: 646-754-9690
Mailing address:
  • Phone: 646-754-2000
  • Fax: 646-754-9690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number260034
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number260034
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: