Provider Demographics
NPI:1093011397
Name:FARAJOLLAH MOTAHEDEH MD PC
Entity Type:Organization
Organization Name:FARAJOLLAH MOTAHEDEH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FARAJOLLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTAHEDEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:718-252-4466
Mailing Address - Street 1:3302 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-252-4466
Mailing Address - Fax:718-258-1558
Practice Address - Street 1:3302 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-252-4466
Practice Address - Fax:718-258-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115284207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty