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General NPI Number Information
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NPI Number | 1215389937
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Entity Type | Organization
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Legal Business Name | MARYAM AGHALAR PHYSICAL MEDICINE AND REHABILITATION PC
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Dates
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Enumeration Date | 07/06/2016
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 9712 63RD DR STE 1B
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City | REGO PARK
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State | NY
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Zip | 11374-2245
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Country | US
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Telephone | 917-957-3725
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Fax |
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Provider Business Mailing Address
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Address Line | 46 OLD POND RD
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City | GREAT NECK
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State | NY
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Zip | 11023-1031
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Country | US
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Telephone | 917-957-3725
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MARYAM AGHALAR
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Credential | D.O
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Telephone | 917-957-3725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 263923
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License Number State | NY
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