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General NPI Number Information
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NPI Number | 1861789976
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Entity Type | Individual
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Provider Name | VAFA TABATABAIE M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/09/2011
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Last Update Date | 05/29/2013
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Provider Practice Location Address
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Address Line | 111 E 210TH ST
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City | BRONX
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State | NY
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Zip | 10467-2401
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Country | US
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Telephone | 718-920-2017
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 YORK AVE APT 9C
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City | NEW YORK
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State | NY
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Zip | 10028-7008
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Country | US
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Telephone | 646-420-0568
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 263972
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License Number State | NY
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