Provider Demographics
NPI:1174194534
Name:BEHROOZ MANDANIPOUR DPM PC
Entity Type:Organization
Organization Name:BEHROOZ MANDANIPOUR DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHROOZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDANIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-926-8855
Mailing Address - Street 1:19 W 34TH ST RM 608
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3006
Mailing Address - Country:US
Mailing Address - Phone:718-926-8855
Mailing Address - Fax:646-308-9202
Practice Address - Street 1:19 W 34TH ST RM 608
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:212-244-7670
Practice Address - Fax:646-308-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty