MEDICARE: DR. AZIM ETEMADI M.D.

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	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	123804	NY

General Provider Information

NPI Number	:	1790806719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AZIM ETEMADI M.D.

Provider Business Mailing Address
First Line	:	108 E 96TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-6217
Country	:	US
Telephone Number	:	212-348-4849
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 E 96TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-6217
Country	:	US
Telephone Number	:	212-348-4849
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	03/15/2024

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