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General NPI Number Information
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NPI Number | 1073827135
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Entity Type | Individual
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Provider Name | RODWAN MAHFOUZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2010
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Last Update Date | 05/04/2020
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Provider Practice Location Address
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Address Line | 587 FIFTH AVE SUITE 801
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City | NEW YORK
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State | NY
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Zip | 10017-8747
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Country | US
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Telephone | 212-249-1600
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Fax | 212-288-0809
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Provider Business Mailing Address
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Address Line | 322 W 57TH ST APT 30Q
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City | NEW YORK
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State | NY
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Zip | 10019-3712
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Country | US
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Telephone | 248-881-7971
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME 120290
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 272478
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License Number State | NY
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