MEDICARE: JALEH HOORFAR DPM

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	213E00000X	Podiatrist	N002950	NY

General Provider Information

NPI Number	:	1679628077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JALEH HOORFAR DPM

Provider Business Mailing Address
First Line	:	565 PARK AVE
Second Line	:
City	:	NYC
State	:	NY
Zip	:	10021
Country	:	US
Telephone Number	:	212-758-0968
Fax Number	:	212-758-3637

Provider Business Practice Location Address
First Line	:	565 PARK AVE
Second Line	:
City	:	NYC
State	:	NY
Zip	:	10021
Country	:	US
Telephone Number	:	212-758-0968
Fax Number	:	212-758-3637

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

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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Directions to “ JALEH HOORFAR DPM” Practice Location

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