MEDICARE: SOODABEH HAERI MD

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	2085R0202X	Diagnostic Radiology Physician	1292861	NY

General Provider Information

NPI Number	:	1245268101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOODABEH HAERI MD

Provider Business Mailing Address
First Line	:	233 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-4924
Country	:	US
Telephone Number	:	718-826-5911
Fax Number	:	718-826-5860

Provider Business Practice Location Address
First Line	:	345 SCHERMERHORN ST
Second Line	:	DOWNTOWN CENTER
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1025
Country	:	US
Telephone Number	:	718-403-3599
Fax Number	:	718-403-3591

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	01/30/2009

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Directions to “ SOODABEH HAERI MD” Practice Location

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