Provider Demographics
NPI:1376513929
Name:HASSANINEJAD-FARAHANI, MASOUMEH JALEH (MD)
Entity Type:Individual
Prefix:DR
First Name:MASOUMEH
Middle Name:JALEH
Last Name:HASSANINEJAD-FARAHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MASOUMEH
Other - Middle Name:JALEH
Other - Last Name:HASSANINEJAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3400 BAINBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2404
Mailing Address - Country:US
Mailing Address - Phone:718-920-8888
Mailing Address - Fax:718-920-7451
Practice Address - Street 1:3400 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:718-920-8888
Practice Address - Fax:718-920-7451
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02147377Medicaid
NYH34984Medicare UPIN
NY617J51Medicare ID - Type Unspecified