Provider Demographics
NPI:1407180961
Name:FAJIRAM, MOJGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOJGAN
Middle Name:
Last Name:FAJIRAM
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 1:400 E 56TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4339
Mailing Address - Country:US
Mailing Address - Phone:212-759-1369
Mailing Address - Fax:212-751-5750
Practice Address - Street 1:400 E 56TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4339
Practice Address - Country:US
Practice Address - Phone:212-759-1369
Practice Address - Fax:212-751-5750
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042369122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist