Provider Demographics
NPI:1215389937
Name:MARYAM AGHALAR PHYSICAL MEDICINE AND REHABILITATION PC
Entity Type:Organization
Organization Name:MARYAM AGHALAR PHYSICAL MEDICINE AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AGHALAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-957-3725
Mailing Address - Street 1:46 OLD POND RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1031
Mailing Address - Country:US
Mailing Address - Phone:917-957-3725
Mailing Address - Fax:
Practice Address - Street 1:9712 63RD DR STE 1B
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2245
Practice Address - Country:US
Practice Address - Phone:917-957-3725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263923208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty