MEDICARE: DR. NEKOU NOWROUZI

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	062443	NY

General Provider Information

NPI Number	:	1396328969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEKOU NOWROUZI

Provider Business Mailing Address
First Line	:	1 BROOKDALE PLZ
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-3139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-2117
Country	:	US
Telephone Number	:	212-686-3686
Fax Number	:

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

Provider Enumeration Date	:	05/03/2021
Last Update Date	:	01/26/2023

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