Healthcare Provider Details

I. General information

NPI: 1952386948
Provider Name (Legal Business Name): FOAD GHAVAMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEAVIEW AVE SUITE 100
STATEN ISLAND NY
10305
US

IV. Provider business mailing address

501 SEAVIEW AVE SUITE 100
STATEN ISLAND NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-0077
  • Fax: 718-667-4103
Mailing address:
  • Phone: 718-667-0077
  • Fax: 718-667-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2161241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: