MEDICARE: NEDJAT BARAVARIAN

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	1223G0001X	General Practice Dentistry	040454-1	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	:	1457552838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEDJAT BARAVARIAN

Provider Business Mailing Address
First Line	:	6561 SAUNDERS ST
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-4252
Country	:	US
Telephone Number	:	516-625-4204
Fax Number	:

Provider Business Practice Location Address
First Line	:	8710 GRAND AVE
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4444
Country	:	US
Telephone Number	:	718-429-8300
Fax Number	:

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	12/26/2013

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