=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982873394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZAFAR REHMANI LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2008
-----------------------------------------------------
Last Update Date | 03/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3466 BRIDGELAND DR STE. 150
-----------------------------------------------------
City | BRIDGETON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63044-2606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-291-2500
-----------------------------------------------------
Fax | 314-291-2687
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 816
-----------------------------------------------------
City | SAINT PETERS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63376-0015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-352-2266
-----------------------------------------------------
Fax | 314-256-2571
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | PAMELA S ISLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-209-8222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------