Healthcare Provider Details

I. General information

NPI: 1164715686
Provider Name (Legal Business Name): BAHRAM JAHANBAKHSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 10/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

175 ADAMS ST APT 9H
BROOKLYN NY
11201-1817
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number279538
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number279538
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: