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General NPI Number Information
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NPI Number | 1821244724
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Entity Type | Individual
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Provider Name | ARDAVAN AKHAVAN M.D,
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Gender | Male
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Dates
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Enumeration Date | 08/11/2008
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 525 E 68TH ST BOX 94, RM F931
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City | NEW YORK
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State | NY
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Zip | 10065-4870
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Country | US
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Telephone | 212-746-5361
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Fax | 212-746-8149
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Provider Business Mailing Address
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Address Line | 525 E 68TH ST BOX 94, RM F931
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City | NEW YORK
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State | NY
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Zip | 10065-4870
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Country | US
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Telephone | 212-746-5361
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Fax | 212-746-8149
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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 | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | MD60282107
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | D0077591
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 254073
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License Number State | NY
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