Healthcare Provider Details

I. General information

NPI: 1538157938
Provider Name (Legal Business Name): MEHRAN SABOORI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 06/15/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 OLD COUNTRY RD
PLAINVIEW NY
11803-4911
US

IV. Provider business mailing address

340 BROADHOLLOW RD
FARMINGDALE NY
11735-4807
US

V. Phone/Fax

Practice location:
  • Phone: 516-932-6007
  • Fax:
Mailing address:
  • Phone: 516-931-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35089195
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number219421
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: