Provider Demographics
NPI:1275689481
Name:YAGHOOBZADEH, HOOMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOOMAN
Middle Name:
Last Name:YAGHOOBZADEH
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 1:407 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5311
Mailing Address - Country:US
Mailing Address - Phone:212-861-3222
Mailing Address - Fax:
Practice Address - Street 1:407 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5311
Practice Address - Country:US
Practice Address - Phone:212-861-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216552207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI30245IMedicare UPIN
NY635P41Medicare ID - Type Unspecified