Provider Demographics
NPI:1083980213
Name:POURRAT MONAHEMI MD PC
Entity Type:Organization
Organization Name:POURRAT MONAHEMI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:POURRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:MONAHEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-482-4803
Mailing Address - Street 1:3795 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2457
Mailing Address - Country:US
Mailing Address - Phone:718-828-5564
Mailing Address - Fax:718-829-7984
Practice Address - Street 1:3795 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2457
Practice Address - Country:US
Practice Address - Phone:718-828-5564
Practice Address - Fax:718-829-7984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163517207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY53D682Medicare UPIN