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General NPI Number Information
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NPI Number | 1093011397
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Entity Type | Organization
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Legal Business Name | FARAJOLLAH MOTAHEDEH MD PC
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Dates
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Enumeration Date | 02/03/2011
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Last Update Date | 10/30/2014
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Provider Practice Location Address
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Address Line | 3302 AVENUE N
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City | BROOKLYN
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State | NY
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Zip | 11234
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Country | US
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Telephone | 718-252-4466
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Fax | 718-258-1558
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Provider Business Mailing Address
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Address Line | 3302 AVENUE N
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City | BROOKLYN
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State | NY
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Zip | 11234
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Country | US
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Telephone | 718-252-4466
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Fax | 718-258-1558
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Authorized Official
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Title or Position | MD
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Name | FARAJOLLAH MOTAHEDEH
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Credential | MD, PC
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Telephone | 718-252-4466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 115284
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License Number State | NY
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