MEDICARE: MOHAMAD IRANI M.D.

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	207VE0102X	Reproductive Endocrinology Physician	036.146445	IL
2	207VE0102X	Reproductive Endocrinology Physician	279078	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036.146445	OTHER	IL	MEDICAL LIC
2	279078	OTHER	NY	MEDICAL LICENSE

General Provider Information

NPI Number	:	1154602670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMAD IRANI M.D.

Provider Business Mailing Address
First Line	:	255 GREENWICH ST RM 540
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-5512
Country	:	US
Telephone Number	:	646-962-7499
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 GREENWICH ST RM 540
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-5512
Country	:	US
Telephone Number	:	646-962-7499
Fax Number	:

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

Provider Enumeration Date	:	08/30/2011
Last Update Date	:	02/12/2024

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