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NPI Code Detail

MEDICARE: ENAYATOLLAH HARIRI M.D.

MEDICARE: ENAYATOLLAH HARIRI 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
1207R00000XInternal Medicine Physician119476NY

Other Identifiers

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

General Provider Information

NPI Number : 1376657247
Entity Type Code : Individual
Provider Name (Legal Business Name) : ENAYATOLLAH HARIRI M.D.
Provider Business Mailing Address
First Line : 33 ASPEN DR
Second Line :
City : LIVINGSTON
State : NJ
Zip : 07039-1430
Country : US
Telephone Number : 718-469-6600
Fax Number : 718-856-0714
Provider Business Practice Location Address
First Line : 2146 BEVERLEY RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-5406
Country : US
Telephone Number : 718-469-6600
Fax Number : 718-856-0714
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 08/17/2015

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