MEDICARE: PARVIZ R MOHASSEL 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	208000000X	Pediatrics Physician	174612	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

General Provider Information

NPI Number	:	1336154889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARVIZ R MOHASSEL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1004
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-0194
Country	:	US
Telephone Number	:	845-856-6671
Fax Number	:	845-858-9903

Provider Business Practice Location Address
First Line	:	123 PIKE ST
Second Line	:	SUITE 209
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-1824
Country	:	US
Telephone Number	:	845-856-6671
Fax Number	:	845-858-9903

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/08/2007

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