MEDICARE: MINOO TAVAZOI

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1700470614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINOO TAVAZOI

Provider Business Mailing Address
First Line	:	252 EMERSON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-3115
Country	:	US
Telephone Number	:	516-450-1780
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 EMERSON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-3115
Country	:	US
Telephone Number	:	516-450-1780
Fax Number	:

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

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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Directions to “ MINOO TAVAZOI ” Practice Location

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