MEDICARE: DR. BEHROOZ MANDANIPOUR DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	N005601	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	A300041434	OTHER		PTAN#

General Provider Information

NPI Number	:	1013955061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEHROOZ MANDANIPOUR DPM

Provider Business Mailing Address
First Line	:	1332 E 36TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2704
Country	:	US
Telephone Number	:	718-926-8855
Fax Number	:	646-308-9202

Provider Business Practice Location Address
First Line	:	1332 E 36TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2704
Country	:	US
Telephone Number	:	718-926-8855
Fax Number	:	646-308-9202

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	04/02/2012

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