Provider Demographics
NPI:1326089673
Name:DARVISH-MAHTABFAR, MAHNAZ (RN, MS, NP-C)
Entity Type:Individual
Prefix:
First Name:MAHNAZ
Middle Name:
Last Name:DARVISH-MAHTABFAR
Suffix:
Gender:F
Credentials:RN, MS, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 GREENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-2012
Mailing Address - Country:US
Mailing Address - Phone:800-842-2478
Mailing Address - Fax:
Practice Address - Street 1:1 PENN PLZ STE 725
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0002
Practice Address - Country:US
Practice Address - Phone:800-842-2478
Practice Address - Fax:212-216-6606
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR10302000163W00000X
NJ26NJ00003300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0066427Medicaid
NJP66139Medicare UPIN