Provider Demographics
NPI:1073534434
Name:ALYESHMERNI, KHOSROW (MD)
Entity Type:Individual
Prefix:
First Name:KHOSROW
Middle Name:
Last Name:ALYESHMERNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10828 68TH DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2951
Mailing Address - Country:US
Mailing Address - Phone:718-896-0100
Mailing Address - Fax:718-896-6002
Practice Address - Street 1:10828 68TH DR
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2951
Practice Address - Country:US
Practice Address - Phone:718-896-0100
Practice Address - Fax:718-896-6002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY154722207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist