Provider Demographics
NPI:1346426087
Name:HOMAYOON HATEFI M.D. PA
Entity Type:Organization
Organization Name:HOMAYOON HATEFI M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOMAYOON
Authorized Official - Middle Name:
Authorized Official - Last Name:HATEFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-445-7776
Mailing Address - Street 1:145 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-4493
Mailing Address - Country:US
Mailing Address - Phone:201-445-7776
Mailing Address - Fax:201-445-4209
Practice Address - Street 1:145 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-4493
Practice Address - Country:US
Practice Address - Phone:201-445-7776
Practice Address - Fax:201-445-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty