Healthcare Provider Details

I. General information

NPI: 1508093766
Provider Name (Legal Business Name): ALIREZA RADMANESH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 01/13/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 1ST AVE FL 2
NEW YORK NY
10016-3282
US

IV. Provider business mailing address

660 1ST AVE FL 2
NEW YORK NY
10016-3282
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5219
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA128343
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number284295
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberA128343
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA128343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: