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General NPI Number Information
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NPI Number | 1942389812
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Entity Type | Organization
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Legal Business Name | MONDANA YAZDI PA
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 219 EVERETT AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-1904
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Country | US
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Telephone | 201-891-4777
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Fax |
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Provider Business Mailing Address
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Address Line | 219 EVERETT AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-1904
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Country | US
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Telephone | 201-891-4777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MONDANA SEPAHI YAZDI
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Credential | M.D., F.A.A.P.
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Telephone | 201-891-4777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MA06164400
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License Number State | NJ
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