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NPI Code Detail

MEDICARE: HAMIDREZA HARRISON FADAVI

MEDICARE: HAMIDREZA HARRISON FADAVI
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
1104100000XSocial Worker128864NY

General Provider Information

NPI Number : 1174461891
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAMIDREZA HARRISON FADAVI
Provider Business Mailing Address
First Line : 350 LINCOLN PL APT 2N
Second Line :
City : BROOKLYN
State : NY
Zip : 11238-5842
Country : US
Telephone Number : 929-664-7247
Fax Number :
Provider Business Practice Location Address
First Line : 631 FOSTER AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-1304
Country : US
Telephone Number : 718-859-2400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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