Provider Demographics
NPI:1275823270
Name:BABAK MOHAJER MD PC
Entity Type:Organization
Organization Name:BABAK MOHAJER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAJER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-260-6505
Mailing Address - Street 1:155 5TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-6802
Mailing Address - Country:US
Mailing Address - Phone:212-260-6505
Mailing Address - Fax:212-260-3060
Practice Address - Street 1:155 5TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6802
Practice Address - Country:US
Practice Address - Phone:212-260-6505
Practice Address - Fax:212-260-3060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194807174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100046036OtherMEDICARE PTAN
NYA100046036OtherMEDICARE PTAN