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General NPI Number Information
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NPI Number | 1871304154
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Entity Type | Organization
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Legal Business Name | DR AMIRIFELI NOUVELLE AVENUE PLLC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 431 POND ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-3402
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Country | US
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Telephone | 617-784-0824
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Fax |
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Provider Business Mailing Address
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Address Line | 604 NEWTON ST
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-3119
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHIDEH AMIRIFELI
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Credential |
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Telephone | 617-784-0824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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