Provider Demographics
NPI:1033424940
Name:IRAJ RAHMATI MD PC
Entity Type:Organization
Organization Name:IRAJ RAHMATI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:IRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-355-1550
Mailing Address - Street 1:15 OLD PARK LN
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2530
Mailing Address - Country:US
Mailing Address - Phone:860-355-1550
Mailing Address - Fax:860-355-0165
Practice Address - Street 1:15 OLD PARK LN
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2530
Practice Address - Country:US
Practice Address - Phone:860-355-1550
Practice Address - Fax:860-355-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTB37769Medicare UPIN