Provider Demographics
NPI:1073552303
Name:MOHEIMANI, CHRISTOPHER HESSAM (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:HESSAM
Last Name:MOHEIMANI
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1259 FISHER AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1012
Practice Address - Country:US
Practice Address - Phone:607-753-1017
Practice Address - Fax:607-753-1091
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211879208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01876228Medicaid
NYG81239Medicare UPIN
NYBB2392Medicare ID - Type Unspecified