Provider Demographics
NPI:1346217791
Name:YASHARPOUR, SASAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SASAN
Middle Name:
Last Name:YASHARPOUR
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 1:2777 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4660
Mailing Address - Country:US
Mailing Address - Phone:718-979-0100
Mailing Address - Fax:718-979-3602
Practice Address - Street 1:2777 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4660
Practice Address - Country:US
Practice Address - Phone:718-979-0100
Practice Address - Fax:718-979-3602
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20442512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02098286Medicaid
H23151Medicare UPIN
NY978151Medicare ID - Type Unspecified