Provider Demographics
NPI:1164592697
Name:ALERASSOOL, MANSOUREH (MD)
Entity Type:Individual
Prefix:DR
First Name:MANSOUREH
Middle Name:
Last Name:ALERASSOOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4487 3RD AVE
Mailing Address - Street 2:THIRD FLOOR MEDICAL CLINIC
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-1526
Mailing Address - Country:US
Mailing Address - Phone:718-960-9000
Mailing Address - Fax:718-960-3685
Practice Address - Street 1:4487 3RD AVE
Practice Address - Street 2:THIRD FLOOR MEDICAL CLINIC
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1526
Practice Address - Country:US
Practice Address - Phone:718-960-9000
Practice Address - Fax:718-960-3685
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine