Healthcare Provider Details

I. General information

NPI: 1518945310
Provider Name (Legal Business Name): MOHSEN PAHLAVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 OLD COUNTRY RD STE 101
PLAINVIEW NY
11803
US

IV. Provider business mailing address

1097 OLD COUNTRY RD STE 101
PLAINVIEW NY
11803-6505
US

V. Phone/Fax

Practice location:
  • Phone: 516-261-9988
  • Fax: 516-612-0071
Mailing address:
  • Phone: 516-261-9988
  • Fax: 516-612-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number229485
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02574830
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: