Provider Demographics
NPI:1144428178
Name:IRYAMI, JAHANGIR
Entity Type:Individual
Prefix:DR
First Name:JAHANGIR
Middle Name:
Last Name:IRYAMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125-10 QUEENS BLVD
Mailing Address - Street 2:1202
Mailing Address - City:KEW GARDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11405
Mailing Address - Country:US
Mailing Address - Phone:718-827-6001
Mailing Address - Fax:718-277-3938
Practice Address - Street 1:1176 LIBERTY AVE
Practice Address - Street 2:2FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3309
Practice Address - Country:US
Practice Address - Phone:718-827-6001
Practice Address - Fax:718-277-3938
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050347-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02351944Medicaid