Provider Demographics
NPI:1275938037
Name:GHAVIMI, FERESHTEH (MD)
Entity Type:Individual
Prefix:
First Name:FERESHTEH
Middle Name:
Last Name:GHAVIMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 93RD ST APT 23H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3960
Mailing Address - Country:US
Mailing Address - Phone:212-410-4322
Mailing Address - Fax:212-410-4322
Practice Address - Street 1:245 E 93RD ST APT 23H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3960
Practice Address - Country:US
Practice Address - Phone:212-410-4322
Practice Address - Fax:212-410-4322
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-108868208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics