Healthcare Provider Details

I. General information

NPI: 1063583581
Provider Name (Legal Business Name): CAROLYN TEHRANI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 15 ATLANTIC AVE
RICHMOND HILL NY
11418
US

IV. Provider business mailing address

119 15 ATLANTIC AVE
RICHMOND HILL NY
11418
US

V. Phone/Fax

Practice location:
  • Phone: 718-805-0700
  • Fax: 718-805-5621
Mailing address:
  • Phone: 718-805-0700
  • Fax: 718-805-5621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberTUV007030
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: