MEDICARE: MORTEZA MODARRES MODARRES GHARAVI DR.

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	103T00000X	Psychologist	026954	NY

General Provider Information

NPI Number	:	1437960366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORTEZA MODARRES MODARRES GHARAVI DR.

Provider Business Mailing Address
First Line	:	2428 84TH ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1605
Country	:	US
Telephone Number	:	917-344-9905
Fax Number	:

Provider Business Practice Location Address
First Line	:	2428 84TH ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1605
Country	:	US
Telephone Number	:	917-344-9905
Fax Number	:

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

Provider Enumeration Date	:	01/20/2025
Last Update Date	:	01/20/2025

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Directions to “ MORTEZA MODARRES MODARRES GHARAVI DR.” Practice Location

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