MEDICARE: KAVEH ALIZADEH

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	174400000X	Specialist	213702	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	:	1770552465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAVEH ALIZADEH

Provider Business Mailing Address
First Line	:	120 E 87TH ST
Second Line	:	#P4B
City	:	NEW YORK
State	:	NY
Zip	:	10128-1116
Country	:	US
Telephone Number	:	929-800-1887
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 E 87TH ST
Second Line	:	#P4B
City	:	NEW YORK
State	:	NY
Zip	:	10128-1116
Country	:	US
Telephone Number	:	929-800-1887
Fax Number	:

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	06/23/2014

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Directions to “ KAVEH ALIZADEH ” Practice Location

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