Healthcare Provider Details

I. General information

NPI: 1548709124
Provider Name (Legal Business Name): PARISA KIUMEHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 PORT WASHINGTON BLVD
PORT WASHINGTON NY
11050-2910
US

IV. Provider business mailing address

23 GEORGIAN LN
GREAT NECK NY
11024-1615
US

V. Phone/Fax

Practice location:
  • Phone: 516-944-6148
  • Fax:
Mailing address:
  • Phone: 516-423-9260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number062586
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: