Provider Demographics
NPI:1215021530
Name:SADIGHIM, EBRAHIM (MD)
Entity Type:Individual
Prefix:
First Name:EBRAHIM
Middle Name:
Last Name:SADIGHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 MIDDLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1246
Mailing Address - Country:US
Mailing Address - Phone:516-466-1910
Mailing Address - Fax:516-466-9390
Practice Address - Street 1:138 MIDDLE NECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1113
Practice Address - Country:US
Practice Address - Phone:516-466-1910
Practice Address - Fax:516-466-9390
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine