Healthcare Provider Details

I. General information

NPI: 1073956264
Provider Name (Legal Business Name): SHAHRAM MAJIDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MADISON AVE # 1-NORTH
NEW YORK NY
10029-6508
US

IV. Provider business mailing address

1450 MADISON AVENUE, BOX 1136
NEW YORK NY
10029-6574
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-9862
  • Fax:
Mailing address:
  • Phone: 212-241-9862
  • Fax: 646-537-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number293068
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number293068
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number293068
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: